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Hypertonic fluid administration in patients with septic shock: A prospective randomized controlled pilot study

Van Haren, Frank; Sleigh, J; Boerma, Christiaan; La Pine, Mary; Bahr, Mohamed; Picckers, Peter; van der Hoeven, Johannes G

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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,...[Show more]

dc.contributor.authorVan Haren, Frank
dc.contributor.authorSleigh, J
dc.contributor.authorBoerma, Christiaan
dc.contributor.authorLa Pine, Mary
dc.contributor.authorBahr, Mohamed
dc.contributor.authorPicckers, Peter
dc.contributor.authorvan der Hoeven, Johannes G
dc.date.accessioned2015-12-13T22:19:48Z
dc.identifier.issn1073-2322
dc.identifier.urihttp://hdl.handle.net/1885/72001
dc.description.abstractWe 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.
dc.publisherLippincott Williams & Wilkins
dc.sourceShock
dc.subjectKeywords: hetastarch; hypertonic solution; isotonic solution; noradrenalin; sodium chloride; adult; article; blood vessel tone; central venous pressure; clinical assessment; comparative study; controlled study; double blind procedure; echocardiography; fluid resusc hydroxyethyl starch; Hypertonic fluid; microcirculation; septic shock; tonometry
dc.titleHypertonic fluid administration in patients with septic shock: A prospective randomized controlled pilot study
dc.typeJournal article
local.description.notesImported from ARIES
local.identifier.citationvolume37
dc.date.issued2012
local.identifier.absfor119999 - Medical and Health Sciences not elsewhere classified
local.identifier.ariespublicationf5625xPUB2998
local.type.statusPublished Version
local.contributor.affiliationVan Haren, Frank, College of Medicine, Biology and Environment, ANU
local.contributor.affiliationSleigh, J, Waikato Hospital
local.contributor.affiliationBoerma, Christiaan, Medical Centre Leeuwarden
local.contributor.affiliationLa Pine, Mary, Waikato Hospital
local.contributor.affiliationBahr, Mohamed, Waikato Hospital
local.contributor.affiliationPicckers, Peter, Radboud University Nijmegen Medical Centre
local.contributor.affiliationvan der Hoeven, Johannes G, Radboud University Nijmegen Medical Centre
local.description.embargo2037-12-31
local.bibliographicCitation.issue3
local.bibliographicCitation.startpage268
local.bibliographicCitation.lastpage275
local.identifier.doi10.1097/SHK.0b013e31823f152f
dc.date.updated2016-02-24T09:04:44Z
local.identifier.scopusID2-s2.0-84857569264
local.identifier.thomsonID000300622300007
CollectionsANU Research Publications

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