[Short term effects of hypertonic saline during severe sepsis and septic shock].
OBJECTIVE
Assessment of haemodynamic effects of 250 ml hypertonic saline 7.5% (HS) perfusion in critically ill patients with severe sepsis or septic shock.


METHODS
Observational study.


METHODS
Twelve mechanically ventilated patients with severe sepsis or septic shock requiring a pulmonary artery catheter and volume loading.


METHODS
Two hundred and fifty millilitres HS were given over 15 min. Were measured: heart rate (HR), mean arterial pressure (MAP) and pulmonary artery pressure (MPAP), pulmonary capillary wedge pressure (PCWP), right atrial pressure (RAP), cardiac index (CI), indexed systemic vascular resistance (ISVR), indexed pulmonary vascular resistance (IPVR), plasma sodium, chloride, protein and haemoglobin concentrations and arterial blood lactate. Studied parameters were assessed at baseline (T(0)) and 5 (T(0)) and 105 min (T(120)) after the end of HS infusion.


RESULTS
MAP, HR and RAP were not altered. HS increased PAPM (25 +/- 5-30 +/- 6 mmHg), PCWP (13 +/- 3-18 +/- 4 mmHg) and CI (3.5 +/- 1.2-4.6 +/- 1.1 l/min per m(2)) at T(20) (P < 0.05). ISVR and IPVR were decreased at T(20). Protein and haemoglobin were decreased at T(20). Sodium and chloride were increased at T(20) (from 136 +/- 4 to 147 +/- 4 and from 110 +/- 6 to 123 +/- 6 mmol/l, respectively, P < 0.01) and T(120).


CONCLUSIONS
In patients with severe sepsis or septic shock, 250 ml HS transiently (<120 min) increases CI and PCWP and induces an increase in sodium and chloride concentrations.
Muller
L
L
Fédération d'anesthésie-douleur-urgences-réanimation, centre hospitalier universitaire de Nîmes, groupe hospitalo-universitaire Carémeau, place du Professeur-Robert-Debré, 30029 Nîmes cedex 09, France. laurent.muller@chu-nimes.fr
Lefrant
J-Y
JY
Jaber
S
S
Louart
G
G
Mahamat
A
A
Ripart
J
J
de La Coussaye
J-E
JE
Eledjam
J-J
JJ
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001798:Blood Proteins / Q000378:metabolism; D002407:Catheterization, Swan-Ganz; D003422:Critical Care; D005260:Female; D006439:Hemodynamics / Q000187:drug effects; D006454:Hemoglobins / Q000378:metabolism; D006801:Humans; D019344:Lactic Acid / Q000097:blood; D008297:Male; D008833:Microcirculation / Q000187:drug effects; D008875:Middle Aged; D011652:Pulmonary Circulation; D012121:Respiration, Artificial; D012462:Saline Solution, Hypertonic / Q000627:therapeutic use*; D018805:Sepsis / Q000188:drug therapy* / Q000503:physiopathology; D012772:Shock, Septic / Q000188:drug therapy* / Q000503:physiopathology; D014882:Water-Electrolyte Balance / Q000187:drug effects / Q000502:physiology
D001798:Blood Proteins; D006454:Hemoglobins; D012462:Saline Solution, Hypertonic; D019344:Lactic Acid