Fluid resuscitation and hyperchloremic acidosis in experimental sepsis: improved short-term survival and acid-base balance with Hextend compared with saline.
OBJECTIVE
To compare resuscitation with 0.9% saline with Hextend, a synthetic colloid in a balanced electrolyte solution, in terms of acid-base status and survival time in an experimental model of septic shock in the rat.


METHODS
Randomized, open-label, controlled experiment.


METHODS
University research laboratory.


METHODS
Sixty adult, male Sprague-Dawley rats.


METHODS
Animals were studied for 12 hrs after intravenous infusion of Escherichia coli endotoxin (20 mg/kg). Animals were volume resuscitated to maintain a mean arterial pressure >60 mm Hg using either 0.9% saline (n = 25), Hextend (n = 25), or lactated Ringer's (n = 10).


METHODS
Arterial blood gases and electrolytes were measured before and after resuscitation (0, 180, 360, and 540 mins after endotoxin infusion). Survival time was measured, up to 12 hrs.


RESULTS
Mean survival time among animals treated with saline or Ringer's was 45% less compared with Hextend-treated animals: 391 +/- 151 mins and 362 +/- 94 mins vs. 567 +/- 140 mins, respectively, p <.0001. Overall survival (at 12 hrs) was 0% with saline or Ringer's vs. 20% with Hextend, p =.05. After resuscitation with saline, arterial standard base excess and plasma apparent strong ion difference were both significantly lower (-19.3 +/- 5.2 vs. -12.1 +/- 5.7, p <.001, and 23.0 +/- 6.2 vs. 30.3 +/- 2.9, p <.0001, respectively) and plasma Cl(-) was significantly higher (123 +/- 7 vs. 115 +/- 3 mmol/L, p <.0001) compared with Hextend. Resuscitation with Ringer's solution resulted in a standard base excess, and Cl(-) between that of saline and Hextend (-15.4 +/- 3.1, and 117 +/- 3, respectively).


CONCLUSIONS
Compared with 0.9% saline, volume resuscitation with Hextend was associated with less metabolic acidosis and longer survival in this experimental animal model of septic shock.
Kellum
John A
JA
Department of Anesthesiology and Critical Care Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA 15213-2582, USA. Kellumja@anes.upmc.edu
D000136:Acid-Base Equilibrium / Q000187:drug effects; D000138:Acidosis / Q000209:etiology / Q000517:prevention & control*; D000704:Analysis of Variance; D000818:Animals; D005440:Fluid Therapy / Q000009:adverse effects / Q000379:methods*; D006895:Hydroxyethyl Starch Derivatives / Q000494:pharmacology*; D008297:Male; D010952:Plasma Substitutes / Q000494:pharmacology*; D011897:Random Allocation; D051381:Rats; D017207:Rats, Sprague-Dawley; D012772:Shock, Septic / Q000401:mortality / Q000628:therapy*; D012965:Sodium Chloride / Q000009:adverse effects; D016019:Survival Analysis
D006895:Hydroxyethyl Starch Derivatives; D010952:Plasma Substitutes; D012965:Sodium Chloride