Assessment of renal hemodynamic toxicity of fluid challenge with 0.9% NaCl compared to balanced crystalloid (PlasmaLyte (R)) in a rat model with severe sepsis

作者：Olivier Pierre Yves; Beloncle Francois; Seegers Valerie; Tabka Maher; de La Bourdonnaye Mathilde Renou; Mercat Alain; Cales Paul; Henrion Daniel; Radermacher Peter; Piquilloud Lise; Lerolle Nicolas; Asfar Pierre^*

来源：Annals of Intensive Care, 2017, 7(1): 66.

DOI：10.1186/s13613-017-0286-1

• Sepsis
• Shock
• Acute kidney injury
• Hemodynamics
• Microcirculation
• Sodium chloride
• PlasmaLyte
• Crystalloid
• Balanced crystalloid

Background: According to international guidelines, volume expansion with crystalloids is the first-line treatment for hemodynamic management in patients with severe sepsis or septic shock. Compared to balanced crystalloids, 0.9% sodium chloride (0.9% NaCl) induces hyperchloremia and metabolic acidosis and may alter renal hemodynamics and function. We compared the effects of 0.9% NaCl to a less chloride-concentrated fluid, PlasmaLyte (R) (PL) in targeted fluid resuscitation in a randomized, double-blind controlled study in an experimental model of severe sepsis in rats.
Results: A sepsis with hypotension was induced by cecal ligature and puncture (CLP) in 40 male Wistar rats (20 for each crystalloid). Rats received fluid resuscitation over a period of 200 min for a targeted mean arterial pressure of 90 mm Hg. Animals received similar volumes of 0.9% NaCl or PL. Unlike PL-resuscitated rats, 0.9% NaCl-resuscitated rats experienced hyperchloremia and metabolic acidosis, whereas systemic hemodynamics, renal hemodynamics and renal function were not significantly different between both groups.
Conclusion: In our model of rats with severe sepsis resuscitated with large amounts of crystalloids, 0.9% NaCl-induced hyperchloremic acidosis, but balanced crystalloid did not improve systemic and renal hemodynamics or renal function.

• 出版日期2017-6-14