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Fluid replacement with hypertonic or isotonic solutions guided by mixed venous oxygen saturation in experimental hypodynamic sepsis.
Rahal, Luciana; Garrido, Alejandra G; Cruz, Ruy J; Silva, Eliezer; Poli-de-Figueiredo, Luiz F.
Afiliação
  • Rahal L; Department of Surgery and LIM26, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
J Trauma ; 67(6): 1205-12, 2009 Dec.
Article em En | MEDLINE | ID: mdl-20009668
BACKGROUND: Splanchnic perfusion is prone to early injury and persists despite normalization of global hemodynamic variables in sepsis. Volume replacement guided by oxygen derived variables has been recommended in the management of septic patients. Our hypothesis was that a hypertonic isoncotic solution would improve the benefits of crystalloids replacement guided by mixed venous oxygen saturation. METHODS: Seventeen anesthetized and mechanically ventilated mongrel dogs received an intravenous infusion of live E. coli in 30 minutes. They were then randomized into three groups: control group (n = 3) bacterial infusion without treatment; normal saline (n = 7), initial fluid replacement with 32 mL/kg of normal saline during 20 minutes; hypertonic solution (n = 7), initial fluid replacement with 4 mL/kg of hypertonic solution during 5 minutes. After 30 and 60 minutes, additional boluses of normal saline were administered when mixed venous oxygen saturation remained below 70%. Mean arterial pressure, cardiac output; regional blood flows, systemic and regional oxygen-derived variables, and lactate levels were assessed. Animals were observed for 90 minutes and then killed. Hystopathological analysis including apoptosis detection using terminal deoxynucleotidil transferase mediated dUTP-biotin nick end labeling was performed. RESULTS: A hypodynamic septic shock was observed after bacterial infusion. Both the fluid-treated groups presented similar transient benefits in systemic and regional variables. A greater degree of gut epithelial cells apoptosis was observed in normal saline-treated animals. CONCLUSIONS: Although normalization of mixed venous oxygen saturation was not associated with restoration of markers of splanchnic or other systemic perfusion variables, the initial fluid savings with hypertonic saline and its latter effect on gut apoptosis may be of interest in sepsis management.
Assuntos

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Oxigênio / Solução Salina Hipertônica / Choque Séptico / Hidratação Tipo de estudo: Prognostic_studies Limite: Animals Idioma: En Revista: J Trauma Ano de publicação: 2009 Tipo de documento: Article País de afiliação: Brasil País de publicação: Estados Unidos

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Oxigênio / Solução Salina Hipertônica / Choque Séptico / Hidratação Tipo de estudo: Prognostic_studies Limite: Animals Idioma: En Revista: J Trauma Ano de publicação: 2009 Tipo de documento: Article País de afiliação: Brasil País de publicação: Estados Unidos