Acute haemodynamic effects of a hypertonic saline/dextran solution in stable patients with severe sepsis

Abstract

Objective. To study the haemodynamic effects of a hypertonic saline/dextran solution compared with a normal saline solution in patients with severe sepsis.

Design. Prospective double blind and control-randomised study.

Setting. Adult intensive care unit in a university hospital.

Patients. Twenty-nine patients with sepsis with a pulmonary artery occlusion pressure (PAOP) lower than 12 mmHg.

Interventions. Patients were randomised to receive 250 ml of blinded solutions of either normal saline (SS group, n=16) or hypertonic saline (NaCl 7.5%)/dextran 70 8% (HSS group, n=13) solutions.

Measurements and results. Haemodynamic, blood gas, and sodium data were collected at the following time points: baseline, 30 min, 60 min, 120 min, and 180 min. PAOP was higher in the HSS group at 30 min (10.7±3.2 mmHg vs 6.8±3.2 mmHg) and 60 min (10.3±3 mmHg vs 7.4±2.9 mmHg); P<0.05. The cardiac index increased in the HSS group and it was greater than the SS group at 30 min (6.5±4.7 l min^–1 m^–2 vs 3.8±3.4 l min^–1 m^–2), 60 min (4.9±4.5 l min^–1 m^–2 vs 3.7±3.3 l min^–1 m^–2), and 120 min (5.0±4.3 l min^–1 m^–2 vs 4.1±3.4 l min^–1 m^–2); P<0.05. The stroke volume index followed a comparable course and it was higher at 30 min [53.6(39.2–62.8) ml m^–2 vs 35.6(31.2–49.2) ml m^–2] and 60 min [46.8(39.7–56.6) ml m^–2 vs 33.9(32.2–47.7) ml m^–2]; P<0.05. Systemic vascular resistance decreased in the HSS group and became significantly lower at 30 min (824±277 dyne s^–1 cm^–5 m^–2 vs 1139±245 dyne s^–1 cm^–5 m^–2), 60 min (921±256 dyne s^–1 cm^–5 m^–2 vs 1246±308 dyne s^–1 cm^–5 m^–2), and 120 min (925±226 dyne s^–1 cm^–5 m^–2 vs 1269±494 dyne s^–1 cm^–5 m^–2). Sodium levels increased in the HSS group (P=0.056) and were higher than in the SS group at 30 min (145±3 mEq l^–1 vs 137±7 mEq l^–1), 60 min (143±4 mEq l^–1 vs 136±7 mEq l^–1), 120 (142±5 mEq l^–1vs 136±7 mEq l^–1), and 180 min (142±5 mEq l^–1 vs 136±8 mEq l^–1).

Conclusion. Hypertonic saline/dextran solution may improve cardiovascular performance in severe sepsis without significant side effects. The haemodynamic effect appears related mainly to a volume effect.