Hemodynamic efficacy and safety of using modified gelatin solution and polyhydric alcohol solution for fluid resuscitation of patients with septic shock
Objective ‒ to compare the hemodynamic effects and safety of the infusion of succinylated gelatin solution, sorbitol-containing solution, and 0.9 % normal saline (0.9 % sodium chloride), analyze their effect on the treatment of septic shock and mortality.
Materials and methods. A prospective randomized clinical trial that included 94 adult patients with an active surgical infection and septic shock was conducted. There were 34 (36.2 %) male and 60 (63.8 %) female patients aged between 19 and 96 years, mean age was (66.51 ± 17.06) years. An appropriate solution in a volume of 500 ml was used for resuscitation, then hemodynamic and other clinical and laboratory parameters were monitored.
Results. There was no significant difference in mean arterial pressure (MAP) between the 3 groups until the 40th minute (p>0.05). At the 45th minute MAP in the NS group differed only from MAP in the Gel group (p=0.007). At the 50th minute MAP in the NS group did not differ from the baseline (p=0.139). From the 50th minute to 2 hours, MAP in the Gel and Sorb groups was higher than in the NS group in all measurements (p<0.05). There was no statistically significant difference in heart rate (HR) in any measurement (p>0.05). Cardiac output (CO) did not differ up to the 30th minute (p>0.05), at the 35th minute, CO differed only between Gel and NS groups (p=0.019), from the 40th minute to 2 hour CO in Gel and Sorb groups were significantly higher than in NS group in all measurements (p<0.05). Oxygen delivery (DO2) also did not differ up to the 30th minute (p>0.05), from the 35th minute to the 45th minute a significant difference was found only between Gel and NS groups (p<0.05), from the 50th minute to 2 hour DO2 in Gel and Sorb group was significantly higher than in NS group in all measurements (p<0.05). After infusion of the gelatin-containing solution and sorbitol-containing solution, the acid-base balance of the blood improved significantly. The dose of gelatin-containing and sorbitol-containing solutions applied in this study was safe for the renal function of the patients with septic shock. However, it is possible that a decrease in blood fibrinogen concentrations may be associated with the use of a gelatin-containing solution. Significant improvement in the Glasgow Coma Scale scores was observed only in patients in the group receiving the sorbitol-containing solution. The difference in 28-day mortality between the groups was not statistically significant (p=0.993).
Conclusions. In our observations, when using these three types of solution in patients with septic shock, hemodynamic effects up to the 40th minute did not differ between groups. From the 40th minute to 2 hour, the volemic effect of 4 % succinylated gelatin solution and balanced polyionic solution with 6 % sorbitol was significantly better, compared to the 0.9 % sodium chloride solution. The volume of solutions used in these three groups did not affect renal function in patients with septic shock. The amount of balanced polyionic solution used with 6 % sorbitol and 0.9 % sodium chloride solution did not affect blood coagulation function. But the use of 4 % succinyl gelatin solution reduced the concentration of fibrinogen in the blood. After infusion of the gelatin-containing solution with buffer formulations and sorbitol-containing solution with buffer formulations, the acid-base status of the blood was significantly improved compared to 0.9 % sodium chloride solution. Infusion of the gelatin-containing solution and 0.9 % sodium chloride solution did not affect the Glasgow coma score in patients. After infusion of the sorbitol-containing solution, patients’ consciousness was improved by this scale. The 28-day mortality did not differ significantly between groups.
Rhodes A, Evans LE, Alhazzani W et al. Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016. Intensive Care Med. 2017;43(3):304-77. https://doi.org/10.1007/s00134-017-4683-6
Angus DC, van der Poll T. Severe sepsis and septic shock. N Engl J Med. 2013;369(9):840-51. https://doi.org/10.1056/NEJMra1208623
Leisman D, Wie B, Doerfler M et al. Association of Fluid Resuscitation Initiation Within 30 Minutes of Severe Sepsis and Septic Shock Recognition With Reduced Mortality and Length of Stay. Ann Emerg Med. 2016;68(3):298-311. https://doi.org/10.1016/j.annemergmed.2016.02.044
Lee SJ, Ramar K, Park JG et al. Increased fluid administration in the first three hours of sepsis resuscitation is associated with reduced mortality: a retrospective cohort study. Chest. 2014;146(4):908-15. https://doi.org/10.1378/chest.13-2702
Tafner P, Chen FK, Rabello RF et al. Recent advances in bedside microcirculation assessment in critically ill patients. Rev Bras Ter Intensiva. 2017;29(2):238-47. https://doi.org/10.5935/0103-507X.20170033
Ince C, Mik EG. Microcirculatory and mitochondrial hypoxia in sepsis, shock, and resuscitation. J Appl Physiol. 2016;120(2):226-35. https://doi.org/10.1152/japplphysiol.00298.2015
Lopez A, Grignola JC, Angulo M et al. Effects of early hemodynamic resuscitation on left ventricular performance and microcirculatory function during endotoxic shock. Intensive Care Med Exp. 2015;3(1):49. https://doi.org/10.1186/s40635-015-0049-y
Correa TD, Vuda M, Blaser AR et al. Effect of treatment delay on disease severity and need for resuscitation in porcine fecal peritonitis. Crit Care Med. 2012;40(10):2841-9. https://doi.org/10.1097/CCM.0b013e31825b916b
HOGAN JJ. THE INTRAVENOUS USE OF COLLOIDAL (GELATIN) SOLUTIONS IN SHOCK. Journal of the American Medical Association. 1915;LXIV(9):721-6. https://doi.org/10.1001/jama.1915.02570350015004
Eralina S, Amanov A, Abdrasulov R. Low-volume infusion therapy in the treatment of cerebral edema in patients with traumatic brain injury, acute cerebrovascular accident. Bulletin of the Kazakh National Medical University. 2015;1:26-30 (In Russian).
Avakov VY, Sayipov RM, Davydov DV, Begmatov SZ, Bazarov AN. Detoxifying properties of Reosorbilact and its effects on hemostasis. Emergency Medicine. 2014;2(51):47-51.
Kovalenko OM. Treatment of the burn shock on a specialized stage. Klinicheskaia khirurgiia. 2019; 86(8). https://doi.org/10.26779/2522-1396.2019.08.55
Datsyuk O. Optimization of infusion therapy in preo-perative period in patients with acute pancreatitis. Klinichna khirurhiia. 2016;7:8-10.
Kligunenko EN, Sorokina EY, Kiz SG et al. Multicomponent purposeful infusion therapy in patients with urgent abdominal surgery. Ukrainian Journal of Hematology and Transfusiology. 2012;4(suppl):190-3 (In Russian).
Singer M, Deutschman CS, Seymour CW et al. The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA. 2016;315(8):801-10. https://doi.org/10.1001/jama.2016.0287
Nguyen HB, Jaehne AK, Jayaprakash N et al. Early goal-directed therapy in severe sepsis and septic shock: insights and comparisons to ProCESS, ProMISe, and ARISE. Crit Care. 2016;20(1):160. https://doi.org/10.1186/s13054-016-1288-3
Annane D, Siami S, Jaber S et al. Effects of fluid resuscitation with colloids vs crystalloids on mortality in critically ill patients presenting with hypovolemic shock: the CRISTAL randomized trial. JAMA. 2013;310(17):1809-17. https://doi.org/10.1001/jama.2013.280502
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