title: Effects of resuscitation with crystalloid fluids on cardiac function in patients with severe sepsis.
abstract: BACKGROUND
  The use of hypertonic crystalloid solutions, including sodium chloride and bicarbonate, for treating severe sepsis has been much debated in previous investigations. We have investigated the effects of three crystalloid solutions on fluid resuscitation in severe sepsis patients with hypotension.
  
  
  METHODS
  Ninety-four severe sepsis patients with hypotension were randomly assigned to three groups. The patients received the following injections within 15 min at initial treatment: Ns group (n = 32), 5 ml/kg normal saline; Hs group (n = 30), with 5 ml/kg 3.5% sodium chloride; and Sb group (n = 32), 5 ml/kg 5% sodium bicarbonate. Cardiac output (CO), systolic blood pressure, mean arterial pressure (MAP), body temperature, heart rate, respiratory rate and blood gases were measured.
  
  
  RESULTS
  There were no differences among the three groups in CO, MAP, heart rate or respiratory rate during the 120 min trial or the 8 hour follow-up, and no significant differences in observed mortality rate after 28 days. However, improvement of MAP and CO started earlier in the Sb group than in the Ns and Hs groups. Sodium bicarbonate increased the base excess but did not alter blood pH, lactic acid or [HCO3]- values; and neither 3.5% hypertonic saline nor 5% sodium bicarbonate altered the Na+, K+, Ca2+ or Cl- levels.
  
  
  CONCLUSIONS
  All three crystalloid solutions may be used for initial volume loading in severe sepsis, and sodium bicarbonate confers a limited benefit on humans with severe sepsis.
  
  
  BACKGROUND
  ISRCTN36748319.
authors.affiliation: The Second Hospital of Nanjing, affiliated with Medical School, Southeast University, 1-1 Zhong-fu Road, Nanjing, Jiangsu, 210003, PR China. fangzhixun@yahoo.com.cn
authors.forename: Zhi Xun
authors.initials: ZX
authors.lastname: Fang
authors.forename: Yu Feng
authors.initials: YF
authors.lastname: Li
authors.forename: Xiao Qing
authors.initials: XQ
authors.lastname: Zhou
authors.forename: Zhen
authors.initials: Z
authors.lastname: Zhang
authors.forename: Jin Song
authors.initials: JS
authors.lastname: Zhang
authors.forename: Hai Ming
authors.initials: HM
authors.lastname: Xia
authors.forename: Guo Ping
authors.initials: GP
authors.lastname: Xing
authors.forename: Wei Ping
authors.initials: WP
authors.lastname: Shu
authors.forename: Ling
authors.initials: L
authors.lastname: Shen
authors.forename: Guo Qing
authors.initials: GQ
authors.lastname: Yin
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001774:Blood Chemical Analysis; D001784:Blood Gas Analysis; D001794:Blood Pressure / Q000187:drug effects; D001831:Body Temperature / Q000187:drug effects; D002302:Cardiac Output / Q000187:drug effects; D002648:Child; D002675:Child, Preschool; D000077324:Crystalloid Solutions; D005260:Female; D006321:Heart / Q000502:physiology*; D006334:Heart Function Tests; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D007022:Hypotension / Q000188:drug therapy*; D007552:Isotonic Solutions / Q000008:administration & dosage / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D012123:Pulmonary Ventilation / Q000187:drug effects; D018805:Sepsis / Q000150:complications* / Q000401:mortality
chemical_list: D000077324:Crystalloid Solutions; D007552:Isotonic Solutions