Effect of fluid resuscitation on mortality and organ function in experimental sepsis models

Brandt, S; Regueira, T; Bracht, H; Porta, F; Takala, J; Hiltebrand, LB; Beldi, G; Lepper, MP; Brügger, LE; Kessler, U; Jakob St, M (2009). Effect of fluid resuscitation on mortality and organ function in experimental sepsis models. Critical care, 13(6), R186. London: BioMed Central 10.1186/cc8179

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Introduction Several recent studies have shown that a positive fluid balance in critical illness is associated with worse outcome. We tested the effects of moderate vs. high-volume resuscitation strategies on mortality, systemic and regional blood flows, mitochondrial respiration, and organ function in two experimental sepsis models. Methods 48 pigs were randomized to continuous endotoxin infusion, fecal peritonitis, and a control group (n = 16 each), and each group further to two different basal rates of volume supply for 24 hours [moderate-volume (10 ml/kg/h, Ringer's lactate, n = 8); high-volume (15 + 5 ml/kg/h, Ringer's lactate and hydroxyethyl starch (HES), n = 8)], both supplemented by additional volume boli, as guided by urinary output, filling pressures, and responses in stroke volume. Systemic and regional hemodynamics were measured and tissue specimens taken for mitochondrial function assessment and histological analysis. Results Mortality in high-volume groups was 87% (peritonitis), 75% (endotoxemia), and 13% (controls). In moderate-volume groups mortality was 50% (peritonitis), 13% (endotoxemia) and 0% (controls). Both septic groups became hyperdynamic. While neither sepsis nor volume resuscitation strategy was associated with altered hepatic or muscle mitochondrial complex I- and II-dependent respiration, non-survivors had lower hepatic complex II-dependent respiratory control ratios (2.6 +/- 0.7, vs. 3.3 +/- 0.9 in survivors; P = 0.01). Histology revealed moderate damage in all organs, colloid plaques in lung tissue of high-volume groups, and severe kidney damage in endotoxin high-volume animals. Conclusions High-volume resuscitation including HES in experimental peritonitis and endotoxemia increased mortality despite better initial hemodynamic stability. This suggests that the strategy of early fluid management influences outcome in sepsis. The high mortality was not associated with reduced mitochondrial complex I- or II-dependent muscle and hepatic respiration.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Intensive Care, Emergency Medicine and Anaesthesiology (DINA) > Clinic and Policlinic for Anaesthesiology and Pain Therapy
04 Faculty of Medicine > Department of Intensive Care, Emergency Medicine and Anaesthesiology (DINA) > Clinic of Intensive Care
04 Faculty of Medicine > Department of Gastro-intestinal, Liver and Lung Disorders (DMLL) > Clinic of Visceral Surgery and Medicine > Visceral Surgery

UniBE Contributor:

Brandt, Sebastian; Regueira, Tomas Emilio; Bracht, Hendrik; Porta, Francesca Margherita; Djafarzadeh, Siamak; Takala, Jukka; Gorrasi, José Antonio; Borotto, Erika; Krejci, Vladimir; Hiltebrand, Luzius and Brügger, Lukas

ISSN:

1364-8535

Publisher:

BioMed Central

Language:

English

Submitter:

Jeannie Wurz

Date Deposited:

04 Oct 2013 15:09

Last Modified:

23 Jan 2018 12:17

Publisher DOI:

10.1186/cc8179

Web of Science ID:

000274567900015

BORIS DOI:

10.7892/boris.30389

URI:

https://boris.unibe.ch/id/eprint/30389 (FactScience: 193067)

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