Effects of resuscitation with crystalloid fluids on cardiac function in patients with severe sepsis

Fang, Zhi Xun; Li, Yu Feng; Zhou, Xiao Qing; Zhang, Zhen; Zhang, Jin Song; Xia, Hai Ming; Xing, Guo Ping; Shu, Wei; Shen, Lei; Yin, Guo Qing

doi:10.1186/1471-2334-8-50

Cited by 44 publications

(22 citation statements)

References 54 publications

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“…For example, no hemodynamic changes were found after administration of a small dose of hypertonic saline (5 mL/kg 3.5% sodium chloride) in patients with severe sepsis compared with normal saline (22). However, also no changes in sodium levels were found in this study, raising the possibility that the dose used was insufficient to cause hemodynamic changes.…”

Section: Discussioncontrasting

confidence: 50%

Hypertonic Fluid Administration in Patients With Septic Shock

Haren

Sleigh

Boerma

et al. 2012

Shock

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We assessed the short-term effects of hypertonic fluid versus isotonic fluid administration in patients with septic shock. This was a double-blind, prospective randomized controlled trial in a 15-bed intensive care unit. Twenty-four patients with septic shock were randomized to receive 250 mL 7.2% NaCl/6% hydroxyethyl starch (HT group) or 500 mL 6% hydroxyethyl starch (IT group). Hemodynamic measurements included mean arterial blood pressure (MAP), central venous pressure, stroke volume index, stroke volume variation, intrathoracic blood volume index, gastric tonometry, and sublingual microcirculatory flow as assessed by sidestream dark field imaging. Systolic tissue Doppler imaging velocities of the medial mitral annulus were measured using echocardiography to assess left ventricular contractility. Log transformation of the ratio MAP divided by the norepinephrine infusion rate (log MAP/NE) quantified the combined effect on both parameters. Compared with the IT group, hypertonic solution treatment resulted in an improvement in log MAP/NE (P = 0.008), as well as an increase in systolic tissue Doppler imaging velocities (P = 0.03) and stroke volume index (P = 0.017). No differences between the groups were found for preload parameters (central venous pressure, stroke volume variation, intrathoracic blood volume index) or for afterload parameters (systemic vascular resistance index, MAP). Hypertonic solution treatment decreased the need for ongoing fluid resuscitation (P = 0.046). No differences between groups were observed regarding tonometry or the sublingual microvascular variables. In patients with septic shock, hypertonic fluid administration did not promote gastrointestinal mucosal perfusion or sublingual microcirculatory blood flow in comparison to isotonic fluid. Independent of changes in preload or afterload, hypertonic fluid administration improved the cardiac contractility and vascular tone compared with isotonic fluid. The need for ongoing fluid resuscitation was also reduced.

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Section: Discussioncontrasting

confidence: 50%

Hypertonic Fluid Administration in Patients With Septic Shock

Haren

Sleigh

Boerma

et al. 2012

Shock

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“…However, our observations are consistent with a recent study investigating the effects of crystalloid fluids on cardiac function in patients with severe sepsis. Fang and colleagues [10] report that the mean arterial pressure and cardiac output improve more quickly in patients treated with 5% sodium bicarbonate than in patients treated with normal saline or hypertonic sodium chloride albeit the benefits of sodium bicarbonate are limited.…”

Section: Discussionmentioning

confidence: 96%

“…Such practices may result in very high local PaCO 2, and reduced plasma ionized calcium resulting in myocardial depression [16]. More recently, a randomized trial of 94 septic patients with hypotension shows a more rapid improvement in mean arterial pressure and cardiac output in those resuscitated with 5% sodium bicarbonate solution than normal saline [10].…”

Section: Introductionmentioning

confidence: 98%

Bicarbonate therapy in the treatment of septic shock: a second look

El-Solh

Jaoude²,

Porhomayon

2010

Intern Emerg Med

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The use of supplemental sodium bicarbonate for the treatment of patients with septic shock and elevated blood lactate levels remains a controversial therapy. We conducted a retrospective study between March 2004 and February 2009 of 36 consecutive patients diagnosed with septic shock who received continuous infusion of bicarbonate therapy. A control group was matched 1:1 for age, site of infection, and predicted mortality by APACHE II. All patients were managed according to standard protocols. The median time until reversal of shock did not achieve statistical significance between the bicarbonate group (44.5 h [95% confidence interval [CI] 34-54] and the control group (55.0 h [95% CI 39-60] (p = 0.09). The median time to liberation of mechanical ventilation was significantly reduced in the bicarbonate group (10 days [95% CI 5.0-13.0] compared to the control group (14 days [95% CI 9.0-19.0], p = 0.02). The length of intensive care unit (ICU) stay was also shorter in the surviving patients who received bicarbonate compared to controls (median 11.5 days (95% CI 6.0-16.0) vs. 16.0 days (95% CI 13.5-19.0), respectively; p = 0.01). However, there was no difference in 28-day mortality between the two study groups (28%; 95% CI 14-45% vs. 33%; 95% CI 19-51%, respectively; p = 0.79). Infusion of sodium bicarbonate in septic patients with arterial hyperlactatemia may facilitate weaning from mechanical ventilation and reduce length of ICU stay.

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“…Des études observationnelles cas-témoins plus récentes rapportent des effets bénéfiques de l'alcalinisation par bicarbonate de sodium des patients critiques avec une diminution de la durée de l'acidémie, la durée de ventilation mécanique et la durée de séjour en réanimation [20] mais certaines rapportent à l'inverse un effet délétère sur la survie [21]. En 2014, Fang et al ont conduit une étude randomisée contrôlée multicentrique et retrouvent des effets bénéfiques de la perfusion de bicarbonate de sodium à 5 % comme soluté de remplissage comparé à du soluté salé isotonique ou hypertonique sur la pression artérielle moyenne et le débit cardiaque chez des patients en choc septique [22]. Malheureusement, les patients du groupe bicarbonate de sodium étaient les moins sévères avec notamment une lactatémie inférieure de moitié aux patients des groupes soluté salé.…”

Section: Acidose Lactiqueunclassified