Abstract
Objective
To study the effect of resuscitation with normal saline on vital organ blood flow and renal function in sepsis.
Design and setting
Randomized controlled cross-over animal study in the animal laboratory of university physiology institute.
Subjects
Six merino cross-ewes.
Interventions
Chronic implantation of flow probes around aorta, coronary, renal and mesenteric arteries. Intravenous administration of live Escherichia coli. Random allocation to normal saline resuscitation (20 ml/kg over 15 min) or observation (control) for 210 min. Continuous measurement of central haemodynamics, organ blood flow and renal function.
Results
Live E. coli induced hyperdynamic sepsis with oliguria (28.3 ± 12.6 to 16.7 ± 11.9 ml/30min) and reduced creatinine clearance (87.9 ± 24.5 to 44.3 ± 34.5 ml/min). During this septic state mesenteric, coronary and renal blood flow increased. During the first hour (early effect) after saline resuscitation, central venous pressure, cardiac output, stroke volume, coronary blood flow, mesenteric blood flow, urine output and creatinine clearance increased, but there was no change in renal blood flow. In the following 2 h these increments were significantly attenuated, but urine output and creatinine clearance remained greater than controls; renal blood flow decreased slightly and the fractional excretion of sodium increased significantly.
Conclusion
In hyperdynamic sepsis resuscitation with normal saline increases central venous pressure, cardiac output, mesenteric blood flow, urine output, creatinine clearance, and fractional excretion of sodium despite a lack of effect on renal blood flow. These effects, however, are transient.
References
Angus DC, Linde-Zwirble WT, Lidicker J, Clermont G, Carcillo J, Pinsky MR (2001) Epidemiology of severe sepsis in the United States: analysis of incidence, outcome, and associated costs of care. Crit Care Med 29:1303–1310
Morimatsu H, Singh K, Uchino S, Bellomo R, Hart G (2004) Early and exclusive use of norepinephrine in septic shock. Resuscitation 62:249–254
Martin C, Papazian L, Perrin G, Saux P, Gouin F (1993) Norepinephrine or dopamine for the treatment of hyperdynamic septic shock? Chest 103:1826–1831
Parker MM, Shelhamer JH, Natanson C, Alling DW, Parrillo JE (1987) Serial cardiovascular variables in survivors and nonsurvivors of human septic shock: heart rate as an early predictor of prognosis. Crit Care Med 15:923–929
Sigurdsson GH, Christenson JT, el-Rakshy MB, Sadek S (1992) Intestinal platelet trapping after traumatic and septic shock. An early sign of sepsis and multiorgan failure in critically ill patients? Crit Care Med 20:458–467
Parrillo JE (1993) Pathogenetic mechanisms of septic shock. N Engl J Med 328:1471–1477
Rivers E, Nguyen B, Havstad S, Ressler J, Muzzin A, Knoblich B et al. (2001) Early goal-directed therapy in the treatment of severe sepsis and septic shock. N Engl J Med 345:1368–1377
Hollenberg SM, Ahrens TS, Annane D, Astiz ME, Chalfin DB, Dasta JF et al. (2004) Practice parameters for hemodynamic support of sepsis in adult patients: 2004 update. Crit Care Med 32:1928–1948
Di Giantomasso D, Morimatsu H, May CN, Bellomo R (2004) Increasing renal blood flow: low-dose dopamine or medium-dose norepinephrine. Chest 125:2260–2267
Di Giantomasso D, May CN, Bellomo R (2003) Vital organ blood flow during hyperdynamic sepsis. Chest 124:1053–1059
Di Giantomasso D, Morimatsu H, May CN, Bellomo R (2003) Intrarenal blood flow distribution in hyperdynamic septic shock: effect of norepinephrine. Crit Care Med 31:2509–2513
Bednarik JA, May CN (1995) Evaluation of a transit-time system for the chronic measurement of blood flow in conscious sheep. J Appl Physiol 78:524–530
Di Giantomasso D, Bellomo R, May CN (2005) The haemodynamic and metabolic effects of epinephrine in experimental hyperdynamic septic shock. Intensive Care Med 31:454–462
Fleming SJ, Dallemagne CR, Endre ZH, Yesberg NE, Cross RB (1992) Acute lowering of plasma oncotic pressure increases filtration fraction and sodium excretion in conscious sheep. Ren Physiol Biochem 15:334–340
Marsh DJ, Sosnovtseva OV, Chon KH, Holstein-Rathlou NH (2005) Nonlinear interactions in renal blood flow regulation. Am J Physiol Regul Integr Comp Physiol 288:R1143–R1159
Bone RC, Balk RA, Cerra FB, Dellinger RP, Fein AM, Knaus WA et al. (1992) Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. The ACCP/SCCM Consensus Conference Committee. American College of Chest Physicians/Society of Critical Care Medicine. Chest 101:1644–1655
Di Giantomasso D, May CN, Bellomo R (2003) Norepinephrine and vital organ blood flow during experimental hyperdynamic sepsis. Intensive Care Med 29:1774–1781
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Wan, L., Bellomo, R. & May, C.N. The effect of normal saline resuscitation on vital organ blood flow in septic sheep. Intensive Care Med 32, 1238–1242 (2006). https://doi.org/10.1007/s00134-006-0232-4
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00134-006-0232-4