title: The effects of hypertonic fluid administration on the gene expression of inflammatory mediators in circulating leucocytes in patients with septic shock: a preliminary study.
abstract: OBJECTIVE
  This study was designed to investigate the effect of hypertonic fluid administration on inflammatory mediator gene expression in patients with septic shock.
  
  
  METHODS
  Prospective, randomized, controlled, double-blind clinical study in a 15-bed mixed intensive care unit in a tertiary referral teaching hospital.
  
  
  METHODS
  Twenty-four patients, who met standard criteria for septic shock, were randomized to receive a bolus of hypertonic fluid (HT, 250 ml 6% HES/7.2% NaCl) or isotonic fluid (IT, 500 ml 6% HES/0.9% NaCl) administered over 15 minutes. Randomization and study fluid administration was within 24 hours of ICU admission for all patients. This trial is registered with ANZCTR.org.au as ACTRN12607000259448.
  
  
  RESULTS
  Blood samples were taken immediately before and 4, 8, 12, and 24 hours after fluid administration. Real-time reverse transcriptase polymerase chain reaction (RT rtPCR) was used to quantify mRNA expression of different inflammatory mediators in peripheral leukocytes. In the HT group, compared with the IT group, levels of gene expression of MMP9 and L-selectin were significantly suppressed (p = 0.0002 and p = 0.007, respectively), and CD11b gene expression tended to be elevated (p = NS). No differences were found in the other mediators examined.
  
  
  CONCLUSIONS
  In septic shock patients, hypertonic fluid administration compared with isotonic fluid may modulate expression of genes that are implicated in leukocyte-endothelial interaction and capillary leakage.The study was performed at the Intensive Care Department, Waikato Hospital, and at the Molecular Genetics Laboratory, University of Waikato, Hamilton, New Zealand.
  
  
  BACKGROUND
  Australia and New Zealand Clinical Trials Register (ANZCTR): ACTRN12607000259448.
authors: Intensive Care Department, The Canberra Hospital, Canberra, Australia. fvanharen@me.com.
authors: Frank Mp
authors: FM
authors: van Haren
authors: James
authors: J
authors: Sleigh
authors: Ray
authors: R
authors: Cursons
authors: Mary
authors: M
authors: La Pine
authors: Peter
authors: P
authors: Pickkers
authors: Johannes G
authors: JG
authors: van der Hoeven