Hypertonic Fluid Administration in Patients With Septic Shock: A Prospective Randomized Controlled Pilot Study.

Author(s): van Haren FM, Sleigh J, Boerma EC, La Pine M, Bahr M, Pickkers P, van der Hoeven JG

Affiliation(s): *Intensive Care Department, The Canberra Hospital, Canberra, Australia; **Intensive Care Department, Waikato Hospital, Hamilton, New Zealand; +Intensive Care Department, Medical Centre Leeuwarden, Leeuwarden, The Netherlands; ++Intensive Care Department, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.

Publication date & source: 2011-11-15, Shock., [Epub ahead of print]

INTRODUCTION.: We assessed the short-term effects of hypertonic fluid versus isotonic fluid administration in patients with septic shock. METHODS.: Double blind PRCT in a 15-bed intensive care unit. Twenty-four patients with septic shock were randomized to receive 250ml 7.2% NaCl/6% hydroxyethylstarch (HT) or 500ml 6% hydroxyethylstarch (IT). Hemodynamic measurements included: mean arterial blood pressure (MAP), central venous pressure (CVP), stroke volume index (SVI), stroke volume variation (SVV), intrathoracic blood volume index (ITBVI), gastric tonometry, sublingual microcirculatory flow as assessed by SDF imaging. Systolic tissue Doppler velocities (TDI) 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. RESULTS.: Compared to the IT group, HT treatment resulted in an improvement in log MAP/NE (p=.008), as well as an increase in systolic TDI velocities (p=.03) and SVI (p=.017). No differences between the groups were found for preload parameters (CVP, SVV, ITBVI) or for afterload parameters (SVRI, MAP). HT treatment decreased the need for on-going fluid resuscitation (p=0.046). No differences between groups were observed regarding tonometry or the sublingual microvascular variables. CONCLUSION.: 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 to isotonic fluid. The need for ongoing fluid resuscitation was also reduced.Trial registration. Australian New Zealand Clinical Trials Registry ACTRN12607000259448.