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hypertonic sodium lactate administration in hyperdynamic septic shock

Hypertonic sodium lactate administration in hyperdynamic sep...

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2016中国中西医结合麻醉学会[CSIA]年会暨第三届全国中西医结合麻醉学术研讨会、河南省中西医结合学会麻醉专业委员会成立大会

作者： Keliang Xie Fuhong Su Jean-Louis Vincent Guolin Wang Yonghao Yu Department of Anesthesiology Tianjin Medical University General Hospital Department of Intensive Care Erasme University Hospital

Objective:hypertonic sodium lactate(HTL) expands intravascular volume and may provide an alternative substrate for cellular *** compared the effects of HTL,hypertonic saline(HTS),0.9%('normal') saline(NS) and Ringer's lactate(RL) on hemodynamics;sublingual and renal microcirculation;renal,mesenteric and brain perfusion;renal and cerebral metabolism;and survival in an ovine model of septic ***:Twenty-eight anesthetized,mechanically ventilated sheep were randomized to receive a bolus infusion(over 15 min) of 3 ml/kg 0.5 M HTL,3 ml/kg 3%HTS,10.8 ml/kg NS or 10.8 ml/kg RL at2,6 and 10 hours after induction of fecal peritonitis,followed by 2-hour infusions of 1 ml/kg/h(HTL and HTS groups) or 3.6 ml/kg/h(NS and RL groups).All animals also received RL and hydroxyethyl starch(ratio 1:1) titrated to maintain pulmonary artery occlusion pressure at baseline levels throughout the ***:Fluid balance was lower in the HTL and HTS groups than in the other groups from 4 *** were similar among groups during the first 12 hours,but thereafter the HTL group had a more pronounced decrease in blood pressure and cardiac *** and renal microcirculatory abnormalities occurred earlier in the HTL group than in the other *** and brain perfusion decreased and L/P increased more rapidly in the HTL than in the other three *** times in the HTL and NS groups were shorter than in the other groups(p=0.003).Conclusion:In an ovine model of septic shock,administration of HTL was associated with earlier onset impaired tissue perfusion and shorter survival *** observations raise concerns about use of HTL in septic shock.

关键词： hypertonic lactate hypertonic saline metabolic alkalosis fluid resuscitation and septic shock

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hypertonic sodium lactate as a supplement fluid in hyperdynamic septic shock

Hypertonic sodium lactate as a supplement fluid in hyperdyna...

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中国中西医结合麻醉学会[CSIA]年会暨第二届全国中西医结合麻醉学术研讨会、江苏省中西医结合学会麻醉专业委员会成立大会

Introduction:hypertonic sodium lactate(HTL) not only exerts intravascular volume expansion with its hypertonicity but also provides an alternative cellular fuel with lactate *** compared the supplementary effects of HTL with hypertonic saline(HTS),normal saline(NS) and-Ringer’s lactate(RL) in a clinically relevant model of ovine septic ***:Twenty-eight anesthetized,mechanically ventilated and invasively monitored sheep received1.5 g/kg autologous feces into the abdominal cavity to induce *** all animals,RL and hydroxyethyl starch(ratio 1:1) were titrated to maintain pulmonary artery occlusion pressure(PAOP) at baseline levels throughout the *** were randomized to HTL,HTS,NS or RL(n=7 for each),and were given at 2,6 and 10 hours a bolus infusion(15 min) of 3 ml/kg of 0.5M HTL 3%HTS,10.8 ml/kg NS or RL,*** fluid infusion consisted of 1 ml/kg(HTL and HTS) and 3.6 ml/kg(NS and RL) for two *** artery and mesenteric artery blood flow were measured using transonic probes(Transonic,USA).Sublingual and kidney surface microcirculation was evaluated using Side-dark field(SDF) *** perfusion at the frontal cortex in the brain and the renal cortex was monitored using laser Doppler flowmetry(Oxford,UK),and microdialysis analysis(CMA 20,CMA,Sweden) was also used to evaluate local metabolism using the lactate/pyruvate ratio(L/P).All animals were observed until ***:Fluid balance in the HTL and HTS groups were similar but lower than either the NS or RL *** was no difference in general hemodynamics during the first 12 hours,but the HTL group had a more pronounced decrease in MAP,CI and LVSWI *** HC03- and pH were higher in the HTL group than in the other groups after the initial bolus;Na+ concentrations were higher in the HTL and HTS groups,while Cl- levels higher in the HTS and NS *** lactate increased transiently after each bolus of HTL and did not d

关键词： edema hypertonic lactate hypertonic saline metabolic alkalosis hyperchloremic acidosis fluid resuscitation and septic shock

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