Volume 2 Supplement 1

ESICM LIVES 2014

Open Access

0727. Normal saline versus ringer´s lactate in experimental sepsis

  • D Orbegozo Cortes1,
  • S Fuhong1,
  • C Santacruz1,
  • K Hosokawa1,
  • H Xinrong1,
  • J Creteur1,
  • J-L Vincent1 and
  • D De Backer1
Intensive Care Medicine Experimental20142(Suppl 1):P49

DOI: 10.1186/2197-425X-2-S1-P49

Published: 26 September 2014

Introduction

The development of hyperchloremic acidosis associated with normal saline (NS) administration may be deleterious in septic shock.

Objectives

To compare the time-course of hemodynamics, organ dysfunction and survival with NS or Ringer's lactate (RL) in an experimental model of severe peritonitis.

Methods

Fourteen adult sheep (24-34 Kg) were anesthetized (midazolam, ketamine and morphine), mechanically ventilated and invasively monitored. A cecotomy was performed to collect autologous feces that were later re-injected into the peritoneal cavity through the abdominal wall to create abdominal sepsis. RL was administered during the surgical procedure. After baseline measurements, animals were randomly allocated to receive only NS or RL titrated to maintain pulmonary artery occlusion pressure at baseline level. Neither vasoactive agents nor antibiotics were used during the experiment. Animals were followed until death or for a maximum of 30 hours. Time-evolution for repeated measurement data was analyzed using a Generalized Estimating Equations approach in SPSS 19.0 (IBM) with a p < 0.05 considered as significant. Data are presented as median with inter-quartile range.

Results

See tables 1, 2 and 3
Table 1

Acid-base parameters

  

T0

T4

T8

T12

T16

T20

T24

T28

Arterial pH

RL

7.41 (7.38-7.44)

7.43 (7.39-7.45)

7.41 (7.36-7.43)

7.37 (7.36-7.38)

7.33 (7.32-7.38)

7.24 (7.18-7.27)

7.12 (7.06-7.18)

7.12 (6.87-7.38)

 

NS

7.40 (7.36-7.49)

7.39 (7.36-7.40)*

7.35 (7.25-7.35)*

7.23 (7.14-7.29)*

7.03 (6.97-7.18)*

7.10 (7.02-7.18)*

6.99 (6.99-6.99)*

-

Arterial PCO2 (mmHg)

RL

36 (32-36)

31 (30-31)

32 (30-32)

33 (31-35)

33 (32-34)

35 (34-37)

35 (32-36)

41 (32-50)

 

NS

34 (33-37)

32 (30-34)

32 (31-34)

32 (31-34)

35 (33-36)

34 (33-34)

33 (33-33)

-

Chloride (mmol/L)

RL

108 (105-109)

110 (106-111)

111 (108-112)

111 (109-114)

113 (112-114)

114 (113-117)

112 (112-113)

110 (109-110)

 

NS

111 (107-113)

115 (112-117)*

121 (117-123)*

126 (122-128)*

127 (124-130)*

128 (125-130)*

126 (126-126)*

-

Arterial Lactate (mmol/L)

RL

1.2 (1.0-1.5)

1.2 (0.9-1.5)

1.4 (1.1-1.7)

1.4 (1.2-1.8)

2.0 (1.3-3.3)

3.7 (3.2-5.4)

6.6 (5.9-10.0)

6.0 (1.1-10.8)

 

NS

1.3 (0.8-1.9)

0.8 (0.7-1.2)

1.1 (0.7-1.3)*

1.5 (1.1-2.1)

5.8 (1.2-7.3)*

3.6 (2.3-4.8)

5.7 (5.7-5.7)

-

* = p < 0.05 compared with RL group

Table 2

Systemic parameters

  

T0

T4

T8

T12

T16

T20

T24

T28

Mean Arterial Pressure (mmHg)

RL

103 (97-111)

90 (77-94)

82 (77-90)

68 (60-85)

59 (55-79)

55 (54-57)

51 (39-57)

36 (26-46)

 

NS

97 (93-109)

88 (79-93)

67 (63-81)*

52 (41-63)*

37 (33-42)*

46 (36-57)*

40 (40-40)*

-

Cardiac Index (L/min/m²)

RL

5.1 (4.0-5.6)

4.4 (3.9-6.6)

4.7 (3.9-5.1)

4.6 (3.4-6.0)

4.3 (3.5-5.4)

4.9 (3.5-5.9)

4.6 (2.7-5.0)

3.9 (3.0-4.7)

 

NS

4.9 (4.0-5.5)

4.8 (3.8-5.5)

3.2 (2.6-4.2)*

2.9 (2.7-3.3)*

2.1 (1.5-2.8)*

3.1 (2.9-3.3)*

1.4 (1.4-1.4)*

-

Diuresis (ml/Kg/H)

RL

1.0 (0.5-2.0)

0.9 (0.6-2.2)

1.3 (0.5-2.3)

1.2 (0.3-2.9)

0.2 (0.0-1.3)

0.1 (0.0-0.4)

0.0 (0.0-0.0)

0.5 (0.0-1.0)

 

NS

1.0 (0.6-1.8)

0.9 (0.7-1.2)

1.3 (0.2-2.8)

0.2 (0.0-0.4)*

0.0 (0.0-0.1)

0.2 (0.0-0.4)

0.0 (0.0-0.0)

-

PaO2/FiO2 ratio

RL

462 (420-493)

482 (364-496)

458 (317-483)

352 (222-444)

266 (220-359)

251 (170-324)

281 (150-298)

138 (64-212)

 

NS

388 (322-420)

385 (284-486)

268 (259-400)*

192 (173-299)

176 (160-292)

217 (177-257)

204 (204-204)

-

* = p < 0.05 compared with RL group

Table 3

Laboratory parameters

  

T0

T4

T8

T12

T16

T20

T24

T28

Creatinine (mg/dL)

RL

0.9 (0.7-1.2)

0.8 (0.6-1.0)

0.9 (0.6-1.0)

1.1 (0.7-1.2)

1.4 (0.9-2.0)

2.0 (1.4-2.7)

3.0 (2.4-3.2)

2.3 (1.4-3.2)

 

NS

0.7 (0.6-1.0)

0.7 (0.6-0.8)

0.7 (0.7-0.9)

1.2 (0.8-1.6)

2.0 (1.1-2.5)

1.5 (1.4-1.6)

2.4 (2.4-2.4)

-

PTT (sec)

RL

32 (28-36)

33 (32-41)

40 (35-47)

45 (40-53)

49 (40-59)

50 (40-61)

60 (49-70)

108 (67-150)

 

NS

36 (24-42)

34 (27-42)

45 (37-47)

55 (46-55)

62 (50-135)

104 (58-150)*

63 (63-63)

-

* = p < 0.05 compared with RL group

Survival time was significantly shorter in the NS group than in the RL group (17 [14-20] hours vs 26 [23-29] hours, p Logrank=0.003).

Conclusions

In this sheep model of severe abdominal sepsis, NS-induced hyperchloremic acidosis was associated with an increased development of organ dysfunction and greater mortality.

Declarations

Grant acknowledgment

Institutional funds only.

Authors’ Affiliations

(1)
Dept of Intensive Care, Erasme Hospital

Copyright

© Cortes et al; licensee Springer. 2014

This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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