A Double-Blind, Randomized Control Trial of Rapidly Infused High Strong Ion Difference (SID) Fluid Versus Hartmann's Solution on Acid-Base Status in Sepsis Patients in the Emergency Department.
Hartmann’s solution
balanced fluid
high strong ion difference
resuscitation
sepsis
Journal
Journal of acute medicine
ISSN: 2211-5587
Titre abrégé: J Acute Med
Pays: China (Republic : 1949- )
ID NLM: 101574304
Informations de publication
Date de publication:
01 Sep 2019
01 Sep 2019
Historique:
entrez:
30
9
2020
pubmed:
1
10
2020
medline:
1
10
2020
Statut:
ppublish
Résumé
Balanced fluids are preferred in initial resuscitation of septic patients based on several recent studies. The Stewart's concept on acid-base balance predicts that high strong ion difference (SID) fluid thus will increase the pH level. To date, the impact of high SID fluid in septic patient with metabolic acidosis remains uncertain. We conducted single center, randomized, double-blind trial to compare the effect of high SID fluid vs. Hartmann's solution on acid-base status in selected sepsis patients in the Emergency Department. Septic patient with hyperlactatemia and metabolic acidosis were randomized to receive either high SID fl uid or Hartmann's solution during initial fl uid resuscitation. The primary outcome measures the pH and bicarbonate levels difference pre- and post- resuscitation. One hundred and sixty-two patients underwent randomization, 81 were assigned each to receive high SID fluid or Hartmann's solution. Both groups had similar baseline characteristics. High SID group received 23.5 mL/kg and the Hartmann's group received 22.7 mL/kg (p = 0.360). High SID fluid increased the mean (± SD) pH by 0.107 (± 0.09) vs. Hartmann's solution by 0.014 (± 0.12), p ≤ 0.001. Mean bicarbonate level increased signifi cantly in high SID group compared to Hartmann's (4.30 ± 3.76 vs. 1.25 ± 3.33, p ≤ 0.001). High SID group had higher post resuscitation lactate clearance than Hartmann's group (25.4 ± 28.3% vs. 12.0 ± 34.1%, p = 0.009). Shorter hospital stay was observed in highSID group 8.04 ± 5.96 days vs. Hartmann's group 12.18 ± 12.41 days (p = 0.048). Both groups showed no difference in incidence of pulmonary oedema, acute kidney injury and mortality. Initial resuscitation using high SID fluid in selected septic patient improves pH and bicarbonate levels. The high SID group had better post resuscitation lactate clearance and shorter hospital stay.
Sections du résumé
BACKGROUND
BACKGROUND
Balanced fluids are preferred in initial resuscitation of septic patients based on several recent studies. The Stewart's concept on acid-base balance predicts that high strong ion difference (SID) fluid thus will increase the pH level. To date, the impact of high SID fluid in septic patient with metabolic acidosis remains uncertain. We conducted single center, randomized, double-blind trial to compare the effect of high SID fluid vs. Hartmann's solution on acid-base status in selected sepsis patients in the Emergency Department.
METHODS
METHODS
Septic patient with hyperlactatemia and metabolic acidosis were randomized to receive either high SID fl uid or Hartmann's solution during initial fl uid resuscitation. The primary outcome measures the pH and bicarbonate levels difference pre- and post- resuscitation.
RESULTS
RESULTS
One hundred and sixty-two patients underwent randomization, 81 were assigned each to receive high SID fluid or Hartmann's solution. Both groups had similar baseline characteristics. High SID group received 23.5 mL/kg and the Hartmann's group received 22.7 mL/kg (p = 0.360). High SID fluid increased the mean (± SD) pH by 0.107 (± 0.09) vs. Hartmann's solution by 0.014 (± 0.12), p ≤ 0.001. Mean bicarbonate level increased signifi cantly in high SID group compared to Hartmann's (4.30 ± 3.76 vs. 1.25 ± 3.33, p ≤ 0.001). High SID group had higher post resuscitation lactate clearance than Hartmann's group (25.4 ± 28.3% vs. 12.0 ± 34.1%, p = 0.009). Shorter hospital stay was observed in highSID group 8.04 ± 5.96 days vs. Hartmann's group 12.18 ± 12.41 days (p = 0.048). Both groups showed no difference in incidence of pulmonary oedema, acute kidney injury and mortality.
CONCLUSIONS
CONCLUSIONS
Initial resuscitation using high SID fluid in selected septic patient improves pH and bicarbonate levels. The high SID group had better post resuscitation lactate clearance and shorter hospital stay.
Identifiants
pubmed: 32995241
doi: 10.6705/j.jacme.201909_9(3).0005
pii: 25545
pmc: PMC7440369
doi:
Types de publication
Journal Article
Langues
eng
Pagination
128-144Informations de copyright
Copyright © 2019 by Taiwan Society of Emergency Medicine & Ainosco Press. All Rights Reserved.
Références
N Engl J Med. 2004 May 27;350(22):2247-56
pubmed: 15163774
Crit Care. 2005 Oct 5;9(5):508-16
pubmed: 16277740
Am J Kidney Dis. 2013 Mar;61(3):523
pubmed: 23291233
Ann Intern Med. 1990 Apr 1;112(7):492-8
pubmed: 2156475
Arch Dis Child. 2006 Sep;91(9):797
pubmed: 16923868
Anesth Analg. 2005 Apr;100(4):1093-106
pubmed: 15781528
JAMA. 2015 Oct 27;314(16):1701-10
pubmed: 26444692
N Engl J Med. 2012 Jul 12;367(2):124-34
pubmed: 22738085
Br J Anaesth. 2014 Nov;113(5):772-83
pubmed: 25326478
Crit Care. 2011;15(5):R238
pubmed: 21995879
Restor Dent Endod. 2013 Feb;38(1):52-4
pubmed: 23495371
N Engl J Med. 2001 Nov 8;345(19):1368-77
pubmed: 11794169
Anesthesiology. 1999 May;90(5):1265-70
pubmed: 10319771
Crit Care Med. 1991 Nov;19(11):1352-6
pubmed: 1935152
Curr Opin Crit Care. 2004 Dec;10(6):529-38
pubmed: 15616397
Shock. 2016 Nov;46(5):480-485
pubmed: 27380535
BMC Infect Dis. 2008 Apr 17;8:50
pubmed: 18419825
Ann Surg. 2012 Jul;256(1):18-24
pubmed: 22580944
J Epidemiol Community Health. 1996 Oct;50(5):545-50
pubmed: 8944863
Cochrane Database Syst Rev. 2012 Jun 13;(6):CD009204
pubmed: 22696382
Intern Emerg Med. 2010 Aug;5(4):341-7
pubmed: 20169423
Aust N Z J Surg. 1999 Jun;69(6):433-7
pubmed: 10392887
JAMA. 2012 Oct 17;308(15):1566-72
pubmed: 23073953
Int J Med Sci. 2012;9(1):59-64
pubmed: 22211091
Crit Care. 2007;11(2):R31
pubmed: 17331245
Ann Intensive Care. 2014 Dec 04;4:38
pubmed: 25625012
Crit Care Med. 2013 Feb;41(2):580-637
pubmed: 23353941
JAMA. 2013 Nov 6;310(17):1809-17
pubmed: 24108515
PLoS One. 2015 Dec 21;10(12):e0145181
pubmed: 26692209
J Intensive Care Med. 2010 Sep;25(5):271-80
pubmed: 20622258
Respir Physiol. 1978 Apr;33(1):9-26
pubmed: 27857