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Ruiz LM, de Oliveira Braga KA, Nepomuceno NA, Correia AT, Ribeiro de Carvalho GH, Vilela VS, Dolhnikoff M, Pêgo-Fernandes PM. Effect of Hypertonic Saline Solution on the Ventilatory Mechanics of Lungs Donated After Brain Death. J Surg Res 2024; 298:109-118. [PMID: 38603941 DOI: 10.1016/j.jss.2024.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 01/18/2024] [Accepted: 02/16/2024] [Indexed: 04/13/2024]
Abstract
INTRODUCTION Brain death (BD) compromises the viability of the lung for donation. Hypertonic saline solution (HSS) induces rapid intravascular volume expansion and immunomodulatory action. We investigated its role in ventilatory mechanics (VMs) and in the inflammatory activity of the lungs of rats subjected to BD. METHODS Wistar rats were divided into four groups: control, n = 10: intact rats subjected to extraction of the heart-lung block; BD, n = 8 (BD): rats treated with isotonic saline solution (4 mL/kg) immediately after BD; hypertonic saline 0 h, n = 9 (Hip.0'): rats treated with HSS (4 mL/kg) immediately after BD; and hypertonic saline 1 h, n = 9 (Hip.60'), rats treated with HSS (4 mL/kg) 60 min after BD. The hemodynamic characteristics, gas exchange, VMs, inflammatory mediators, and histopathological evaluation of the lung were evaluated over 240 min of BD. RESULTS In VMs, we observed increased airway resistance, tissue resistance, tissue elastance, and respiratory system compliance in the BD group (P < 0.037), while the treated groups showed no impairment over time (P > 0.05). In the histological analysis, the BD group showed a greater area of perivascular edema and a higher neutrophil count than the control group and the Hip.60' group (P < 0.05). CONCLUSIONS Treatment with HSS was effective in preventing changes in the elastic and resistive pulmonary components, keeping them at baseline levels. Late treatment reduced perivascular and neutrophilic edema in lung tissue.
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Affiliation(s)
- Liliane Moreira Ruiz
- Laboratorio de Pesquisa em Cirurgia Toracica, Instituto do Coração (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Sao Paulo, Brazil.
| | - Karina Andrighetti de Oliveira Braga
- Laboratorio de Pesquisa em Cirurgia Toracica, Instituto do Coração (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Sao Paulo, Brazil
| | - Natalia Aparecida Nepomuceno
- Laboratorio de Pesquisa em Cirurgia Toracica, Instituto do Coração (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Sao Paulo, Brazil
| | - Aristides Tadeu Correia
- Laboratorio de Pesquisa em Cirurgia Toracica, Instituto do Coração (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Sao Paulo, Brazil
| | | | - Vanessa Sana Vilela
- Doctoral Student, Laboratory of Thoracic Surgery Research, Heart Institute (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Sao Paulo, Brazil
| | - Marisa Dolhnikoff
- Pathology Departament, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Sao Paulo, Brazil
| | - Paulo Manuel Pêgo-Fernandes
- Laboratorio de Pesquisa em Cirurgia Toracica, Instituto do Coração (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Sao Paulo, Brazil
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García AF, Manzano-Nunez R, Carrillo DC, Chica-Yanten J, Naranjo MP, Sánchez ÁI, Mejía JH, Ospina-Tascón GA, Ordoñez CA, Bayona JG, Puyana JC. Hypertonic saline infusion does not improve the chance of primary fascial closure after damage control laparotomy: a randomized controlled trial. World J Emerg Surg 2023; 18:4. [PMID: 36624448 PMCID: PMC9830760 DOI: 10.1186/s13017-023-00475-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 01/04/2023] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Previous observational studies showed higher rates of abdominal wall closure with the use of hypertonic saline in trauma patients with abdominal injuries. However, no randomized controlled trials have been performed on this matter. This double-blind randomized clinical trial assessed the effect of 3% hypertonic saline (HS) solution on primary fascial closure and the timing of abdominal wall closure among patients who underwent damage control laparotomy for bleeding control. METHODS Double-blind randomized clinical trial. Patients with abdominal injuries requiring damage control laparotomy (DCL) were randomly allocated to receive a 72-h infusion (rate: 50 mL/h) of 3% HS or 0.9 N isotonic saline (NS) after the index DCL. The primary endpoint was the proportion of patients with abdominal wall closure in the first seven days after the index DCL. RESULTS The study was suspended in the first interim analysis because of futility. A total of 52 patients were included. Of these, 27 and 25 were randomly allocated to NS and HS, respectively. There were no significant differences in the rates of abdominal wall closure between groups (HS: 19 [79.2%] vs. NS: 17 [70.8%]; p = 0.71). In contrast, significantly higher hypernatremia rates were observed in the HS group (HS: 11 [44%] vs. NS: 1 [3.7%]; p < 0.001). CONCLUSION This double-blind randomized clinical trial showed no benefit of HS solution in primary fascial closure rates. Patients randomized to HS had higher sodium concentrations after the first day and were more likely to present hypernatremia. We do not recommend using HS in patients undergoing damage control laparotomy. Trial registration The trial protocol was registered in clinicaltrials.gov (identifier: NCT02542241).
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Affiliation(s)
- Alberto F. García
- grid.477264.4Department of Surgery, Fundación Valle del Lili, Cali, Colombia ,grid.477264.4Department of Intensive Care, Fundación Valle del Lili , Cali, Colombia ,grid.477264.4Clinical Research Center, Fundación Valle del Lili , Cali, Colombia ,grid.8271.c0000 0001 2295 7397Department of Surgery, School of Medicine, Universidad del Valle, Cali, Colombia
| | - Ramiro Manzano-Nunez
- grid.430994.30000 0004 1763 0287Vall d’Hebron Institute of Research, Barcelona, Spain ,grid.411083.f0000 0001 0675 8654Vall d’Hebron Hospital Universitari, Barcelona, Spain ,grid.7080.f0000 0001 2296 0625Universitat Autònoma de Barcelona, Barcelona, Spain
| | | | - Julian Chica-Yanten
- grid.477264.4Clinical Research Center, Fundación Valle del Lili , Cali, Colombia
| | - María Paula Naranjo
- grid.477264.4Clinical Research Center, Fundación Valle del Lili , Cali, Colombia ,Present Address: Department of Surgery, Universidad Sanitas, Bogotá, Colombia
| | - Álvaro I. Sánchez
- grid.477264.4Department of Surgery, Fundación Valle del Lili, Cali, Colombia ,grid.477264.4Clinical Research Center, Fundación Valle del Lili , Cali, Colombia
| | - Jorge Humberto Mejía
- grid.477264.4Department of Intensive Care, Fundación Valle del Lili , Cali, Colombia
| | - Gustavo Adolfo Ospina-Tascón
- grid.477264.4Department of Intensive Care, Fundación Valle del Lili , Cali, Colombia ,grid.440787.80000 0000 9702 069X Translational Research Laboratory in Critical Care Medicine (TransLab-CCM), Universidad Icesi, Cali, Colombia
| | - Carlos A. Ordoñez
- grid.477264.4Department of Surgery, Fundación Valle del Lili, Cali, Colombia ,grid.477264.4Department of Intensive Care, Fundación Valle del Lili , Cali, Colombia ,grid.8271.c0000 0001 2295 7397Department of Surgery, School of Medicine, Universidad del Valle, Cali, Colombia
| | - Juan Gabriel Bayona
- grid.41312.350000 0001 1033 6040 Department of Surgery, Universidad Javeriana, Bogotá, Colombia
| | - Juan Carlos Puyana
- grid.21925.3d0000 0004 1936 9000Professor of Surgery Director Global Health, Critical Care and Clinical Translational Surgery, University of Pittsburgh, Pittsburgh, PA USA
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Hypertonic Saline Treatment in Traumatic Brain Injury: A Systematic Review. World Neurosurg 2022; 162:98-110. [DOI: 10.1016/j.wneu.2022.03.056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 03/13/2022] [Accepted: 03/14/2022] [Indexed: 11/17/2022]
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Huang C, Liu Y, Li L, Liu H, Zhang P. Continuous veno-venous hemofiltration in the treatment of severely burned patients with acute hypernatremia: A retrospective study of 13 cases. Int J Artif Organs 2019; 43:416-421. [PMID: 31849258 DOI: 10.1177/0391398819893381] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES This study aimed to evaluate the clinical effects of continuous veno-venous hemofiltration in the treatment of severely burned patients with acute hypernatremia. METHODS A total of 13 severely burned patients with acute hypernatremia admitted to Xijing Hospital were included in this study. All patients received continuous veno-venous hemofiltration treatment in addition to conventional treatment. The original sodium level in the replacement fluid was set to be lower than the serum sodium level by 8 mmol/L and subsequently undergoes a reduction rate of 2.16 ± 0.18 mmol/L every 4 h. Patients' clinical features, serum laboratory tests, hemodynamic variables, changes in sodium levels in serum, and replacement fluid during continuous veno-venous hemofiltration treatment were monitored. RESULTS Patients had an average total burn surface area of 66.69% ± 20.28%. Two patients died of systematic Pseudomonas aeruginosa infections, and 11 patients survived. After continuous veno-venous hemofiltration treatment, patients showed a significant reduction in the serum sodium level (168.91 ± 4.88 mmol/L vs 144.62 ± 2.98 mmol/L, p < 0.01). Likewise, the serum levels of urea and creatinine decreased from 24.8 ± 6.5 mmol/L to 14.9 ± 8.3 mmol/L and from 278.6 ± 155.3 μmol/L to 152.6 ± 29.7 μmol/L, respectively (p < 0.05). The patients also displayed improvements in the Acute Physiology and Chronic Health Evaluation II and Glasgow scores (p < 0.05) and showed a significant reduction in hemoglobin and serum albumin levels (p < 0.05), but no obvious change in levels of platelets, alanine aminotransferase, and aspartate aminotransferase (p > 0.05). CONCLUSION Our results indicate that continuous veno-venous hemofiltration with gradient sodium replacement fluid is effective in treating hypernatremia in severely burned patients with the controllable sodium reduction rate and satisfactory clinical outcomes.
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Affiliation(s)
- Chen Huang
- Department of Nephrology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Yirong Liu
- Department of Nephrology, Xining No. 1 People's Hospital, Xining, China
| | - Li Li
- Department of Nephrology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Hongbao Liu
- Department of Nephrology, Tangdu Hospital, Fourth Military Medical University, Xi'an, China
| | - Peng Zhang
- Department of Nephrology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
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Giudice E, Crinò C, Macrì F, Di Pietro S. Limited fluid volume resuscitation (LFVR) in severe shock unresponsive to initial fluid challenge: A pilot study in 10 cats. Vet Anaesth Analg 2018; 45:782-787. [PMID: 30301662 DOI: 10.1016/j.vaa.2018.06.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Revised: 04/16/2018] [Accepted: 06/19/2018] [Indexed: 01/16/2023]
Abstract
OBJECTIVE To evaluate the effect of limited fluid volume resuscitation (LFVR) administration in cats with severe shock that was unresponsive to initial conventional resuscitation (CR) with isotonic crystalloids. STUDY DESIGN Clinical pilot study. ANIMALS Ten client-owned cats with non-cardiogenic shock, unresponsive to CR. METHODS After an initial ineffective CR with isotonic crystalloids (15-20 mL kg-1 in 15 minutes), LFVR was started. The animals were randomly assigned to one of two treatments: hypertonic saline alone (group HTS) or HTS and hydroxyethyl starch (HES) (group HTS/HES). A first bolus of HTS (2 mL kg-1) was administered to both groups, immediately followed by HES (2 mL kg-1) to group HTS/HES over 5-10 minutes and vital signs were re-evaluated. Additional boluses were administered, every 5-10 minutes, until stabilization (vital parameters, such as temperature, heart rate, respiratory frequency, quality of the pulse and sensorium within the physiological ranges). The time until stabilization (minutes), the volume of HTS and colloid administered and the effect of LFVR on vital parameters were determined. RESULTS A mean ± standard deviation (range) volume of 3 ± 2 (2-6) mL kg-1 of hypertonic saline in group HTS and 4 ± 2 (2-6) mL kg-1 of both hypertonic and colloidal solutions in group HTS/HES was administered. In six cats (60%), a single bolus of HTS alone (group HTS; n = 3/4) or in combination with HES (group HTS/HES; n = 3/6) was sufficient for stabilization. In the remaining four cases (40%), a second bolus was required. Stabilization occurred in 33 ± 13 minutes (15-60 minutes). Of the 10 cats, six had a positive outcome (6-24 months follow-up) and the others died during hospitalization. CONCLUSIONS AND CLINICAL RELEVANCE LFVR appears to be an efficacious treatment for feline shock and may be an alternative therapy for cats unresponsive to CR. Larger cross-sectional and prospective studies are needed to confirm these findings.
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Affiliation(s)
- Elisabetta Giudice
- Department of Chemical, Biological, Pharmaceutical and Environmental Sciences, University of Messina, Messina, Italy
| | - Chiara Crinò
- Department of Veterinary Sciences, University of Messina, Messina, Italy
| | - Francesco Macrì
- Department of Veterinary Sciences, University of Messina, Messina, Italy
| | - Simona Di Pietro
- Department of Veterinary Sciences, University of Messina, Messina, Italy.
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Abstract
Intravenous fluid management of trauma patients is fraught with complex decisions that are often complicated by coagulopathy and blood loss. This review discusses the fluid management in trauma patients from the perspective of the developing world. In addition, the article describes an approach to specific circumstances in trauma fluid decision-making and provides recommendations for the resource-limited environment.
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Prehospital intravenous fluid is associated with increased survival in trauma patients. J Trauma Acute Care Surg 2013; 75:S9-15. [PMID: 23778518 DOI: 10.1097/ta.0b013e318290cd52] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Delivery of intravenous crystalloid fluids (IVF) remains a tradition-based priority during prehospital resuscitation of trauma patients. Hypotensive and targeted resuscitation algorithms have been shown to improve patient outcomes. We hypothesized that receiving any prehospital IVF is associated with increased survival in trauma patients compared with receiving no prehospital IVF. METHODS Prospective data from 10 Level 1 trauma centers were collected. Patient demographics, prehospital IVF volume, prehospital and emergency department vital signs, lifesaving interventions, laboratory values, outcomes, and complications were collected and analyzed. Patients who did or did not receive prehospital IVF were compared. Tests for nonparametric data were used to assess significant differences between groups (p ≤ 0.05). Cox regression analyses were performed to determine the independent influence of IVF on outcome and complications. RESULTS The study population consisted of 1,245 trauma patients; 45 were excluded owing to incomplete data; 84% (n = 1,009) received prehospital IVF, and 16% (n = 191) did not. There was no difference between the groups with respect to sex, age, and Injury Severity Score (ISS). The on-scene systolic blood pressure was lower in the IVF group (110 mm Hg vs. 100 mm Hg, p < 0.04) and did not change significantly after IVF, measured at emergency department admission (110 mm Hg vs. 105 mm Hg, p = 0.05). Hematocrit/hemoglobin, fibrinogen, and platelets were lower (p < 0.05), and prothrombin time/international normalized ratio and partial thromboplastin time were higher (p < 0.001) in the IVF group. The IVF group received a median fluid volume of 700 mL (interquartile range, 300-1,300). The Cox regression revealed that prehospital fluid administration was associated with increased survival (hazard ratio, 0.84; 95% confidence interval, 0.72-0.98; p = 0.03). Site differences in ISS and fluid volumes were demonstrated (p < 0.001). CONCLUSION Prehospital IVF volumes commonly used by PRospective Observational Multicenter Massive Transfusion Study (PROMMTT) investigators do not result in increased systolic blood pressure but are associated with decreased in-hospital mortality in trauma patients compared with patients who did not receive prehospital IVF.
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[Management of penetrating abdominal trauma: what we need to know?]. ACTA ACUST UNITED AC 2013; 32:104-11. [PMID: 23402982 DOI: 10.1016/j.annfar.2012.12.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2012] [Accepted: 12/13/2012] [Indexed: 12/25/2022]
Abstract
Penetrating traumas are rare in France and mainly due to stabbing. Knives are less lethal than firearms. The initial clinical assessment is the cornerstone of hospital care. It remains a priority and can quickly lead to a surgical treatment first. Urgent surgical indications are hemorrhagic shock, evisceration and peritonitis. Dying patients should be immediately taken to the operating room for rescue laparotomy or thoracotomy. Ultrasonography and chest radiography are performed before damage control surgery for hemodynamic unstable critical patients. Stable patients are scanned by CT and in some cases may benefit from non-operative strategy. Mortality remains high, initially due to bleeding complications and secondarily to infectious complications. Early and appropriate surgery can reduce morbidity and mortality. Non-operative strategy is only possible in selected patients in trained trauma centers and with intensive supervision by experienced staff.
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Lang SS, Kofke WA, Stiefel MF. Monitoring and intraoperative management of elevated intracranial pressure and decompressive craniectomy. Anesthesiol Clin 2012; 30:289-310. [PMID: 22901611 DOI: 10.1016/j.anclin.2012.05.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Elevated intracranial pressure can be caused by a variety of underlying conditions. Several physiologic and pharmacologic factors have a significant impact on intracranial hypertension, mostly caused by changes on cerebral blood volume, flow, and oxygenation. There are many therapies that can be used to decrease intracranial pressure ranging from pharmacologic to the surgical decompressive removal of the calvarium. Special consideration is made for the anesthetic management of these patients perioperatively.
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Affiliation(s)
- Shih-Shan Lang
- Department of Neurosurgery, University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA.
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Galvagno SM, Mackenzie CF. New and future resuscitation fluids for trauma patients using hemoglobin and hypertonic saline. Anesthesiol Clin 2012; 31:1-19. [PMID: 23351531 DOI: 10.1016/j.anclin.2012.10.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Hemoglobin-based oxygen carriers (HBOC) and hypertonic saline solutions (HSS) are used for resuscitation of trauma patients with hemorrhagic shock. In this review, the clinical application, dosing, administration, and side effects of these solutions are discussed. Although HBOC and HSS are not ideal resuscitation fluids, until rapidly thawed universal donor frozen blood and blood component therapy becomes widely available in North America, these fluids should to be considered immediately after injury and throughout the spectrum of care for patients with hemorrhagic shock, until blood and blood components become available.
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Affiliation(s)
- Samuel M Galvagno
- Division of Trauma Anesthesiology (Program in Trauma, R Adams Cowley Shock Trauma Center), Department of Anesthesiology, Shock Trauma Anesthesia Organized Research Center (STAR ORC), University of Maryland School of Medicine, Baltimore, MD 21201, USA
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Current world literature. Curr Opin Anaesthesiol 2012; 25:629-38. [PMID: 22955173 DOI: 10.1097/aco.0b013e328358c68a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Controversies in the management of adults with severe traumatic brain injury. AACN Adv Crit Care 2012; 23:188-203. [PMID: 22543492 DOI: 10.1097/nci.0b013e31824db4f3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Despite progress in the management of adults with severe traumatic brain injury, several controversies persist. Among the unresolved issues of greatest concern to neurocritical care clinicians and scientists are the following: (1) the best use of technological advances and the data obtained from multimodality monitoring; (2) the use of mannitol and hypertonic saline in the management of increased intracranial pressure; (3) the use of decompressive craniectomy and barbiturate coma in refractory increased intracranial pressure; (4) therapeutic hypothermia as a neuroprotectant; (5) anemia and the role of blood transfusion; and (6) venous thromboembolism prophylaxis in severe traumatic brain injury. Each of these strategies for managing severe traumatic brain injury, including the postulated mechanism(s) of action and beneficial effects of each intervention, adverse effects, the state of the science, and critical care nursing implications, is discussed.
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van Haren FM, Sleigh J, Cursons R, La Pine M, Pickkers P, van der Hoeven JG. The effects of hypertonic fluid administration on the gene expression of inflammatory mediators in circulating leucocytes in patients with septic shock: a preliminary study. Ann Intensive Care 2011; 1:44. [PMID: 22044529 PMCID: PMC3217886 DOI: 10.1186/2110-5820-1-44] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2011] [Accepted: 11/01/2011] [Indexed: 11/12/2022] Open
Abstract
Objective This study was designed to investigate the effect of hypertonic fluid administration on inflammatory mediator gene expression in patients with septic shock. Design and setting Prospective, randomized, controlled, double-blind clinical study in a 15-bed mixed intensive care unit in a tertiary referral teaching hospital. Interventions Twenty-four patients, who met standard criteria for septic shock, were randomized to receive a bolus of hypertonic fluid (HT, 250 ml 6% HES/7.2% NaCl) or isotonic fluid (IT, 500 ml 6% HES/0.9% NaCl) administered over 15 minutes. Randomization and study fluid administration was within 24 hours of ICU admission for all patients. This trial is registered with ANZCTR.org.au as ACTRN12607000259448. Results Blood samples were taken immediately before and 4, 8, 12, and 24 hours after fluid administration. Real-time reverse transcriptase polymerase chain reaction (RT rtPCR) was used to quantify mRNA expression of different inflammatory mediators in peripheral leukocytes. In the HT group, compared with the IT group, levels of gene expression of MMP9 and L-selectin were significantly suppressed (p = 0.0002 and p = 0.007, respectively), and CD11b gene expression tended to be elevated (p = NS). No differences were found in the other mediators examined. Conclusions In septic shock patients, hypertonic fluid administration compared with isotonic fluid may modulate expression of genes that are implicated in leukocyte-endothelial interaction and capillary leakage. The study was performed at the Intensive Care Department, Waikato Hospital, and at the Molecular Genetics Laboratory, University of Waikato, Hamilton, New Zealand. Trial registration Australia and New Zealand Clinical Trials Register (ANZCTR): ACTRN12607000259448
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