Updates in management of early stage of sepsis, comparative study between hypertonic saline 7.5%and hydroxy ethyl starch 130/0.4

Abstract

Introduction: Sepsis-related mortality is a leading cause of death worldwide. Early fluid resuscitation of patients with systemic inflammatory response syndrome reduces the incidence of mortality. Aggressive intravenous fluid resuscitation is a critical component of early goal directed therapy. The etiology of sepsis is based on sustained period of hypoperfusion of vital organs. A recent trial compared HES (130/0.4) with crystalloids showed no difference in renal dysfunction between the two groups and no difference in mortality up to 90 days after treatment initiation. However, significantly less volume was required to achieve hemodynamic stability for HES in the initial phase of fluid resuscitation The use of hypertonic saline as an early resuscitation to improve survival, prevents circulatory failure, alleviates multiple organ dysfunction syndrome and decreases mortality rate The aim of the study To compare the effect of early administration of hypertonic saline(HTS) 7.5 % versus hydroxylethyl starch (HES)130/0.4 on adequacy of resuscitation, progression of inflammation and outcome of septic patients. Patients and methods: Our study was a prospective randomized study conducted in the department of ICU in Ain Shams University Hospitals. 150 patients with diagnosis of sepsis syndrome were randomly divided into three groups, group A received 4.ml HTS 7.5%,group B received up to 30 ml HES 130/0.4 and group C received SMT alone. Results:Our study demonstrated that there is no significant difference between study groups on the incidence of septic shock, need for mechanical ventilation, renal replacement therapy and ICU mortality. Conclusion:. We concluded from our study that HTS has no inferior results on critically ill septic patients and significantly reduced inflammatory markersas well as total volume infused over 24 hour after treatment. References: • Finfer S, Liu B, Taylor C, et al. Resuscitation fluid use in critically ill adults: an international cross-sectional study in 391 intensive care units. Crit Care 2010; 14:R185. • Guidet B, Martinet O, Boulain T, et al. Assessment of hemodynamic efficacy and safety of 6%HES 130/0.4 in patients with severe sepsis: The CRYSTMAS study. Critical Care 2012, 16:R94. • Shih C, Chen S, Chen A, et al. Therapeutic effects of HTS on peritonitis induced septic shock with multiple organ dysfunction syndrome in rats. Crit CareMed 2008; 36:1864–1872.