Research article

Effects of resuscitation with crystalloid fluids on cardiac function in patients with severe sepsis

Zhi Xun Fang¹ , Yu Feng Li² , Xiao Qing Zhou³ , Zhen Zhang⁴ , Jin Song Zhang⁵ , Hai Ming Xia¹ , Guo Ping Xing³ , Wei Ping Shu¹ , Ling Shen¹ and Guo Qing Yin¹

¹  The Second Hospital of Nanjing, affiliated with Medical School, Southeast University, 1-1 Zhong-fu Road, Nanjing, Jiangsu, 210003, P.R. China

²  The First People's Hospital of Huai'an City, 3 Beijing Road, Huai'an City, Jiangsu, 223300, P.R. China

³  The People's Hospital of Gaochun County, Gaochun County, Jiangsu, 211300, P.R China

⁴  The Emergency Department of the First Hospital of Nanjing, affiliated with Nanjing Medical University, 68 Chang-le Road, Nanjing, Jiangsu, 210006, P.R. China

⁵  The Emergency Department of the Jiangsu Province Hospital, affiliated with Nanjing Medical University. 300 Guangzhou Road, Nanjing, Jiangsu, 210029, P.R. China

author email corresponding author email

BMC Infectious Diseases 2008, 8:50doi:10.1186/1471-2334-8-50

Published:	17 April 2008

Abstract

Background

The use of hypertonic crystalloid solutions, including sodium chloride and bicarbonate, for treating severe sepsis has been much debated in previous investigations. We have investigated the effects of three crystalloid solutions on fluid resuscitation in severe sepsis patients with hypotension.

Methods

Ninety-four severe sepsis patients with hypotension were randomly assigned to three groups. The patients received the following injections within 15 min at initial treatment: Ns group (n = 32), 5 ml/kg normal saline; Hs group (n = 30), with 5 ml/kg 3.5% sodium chloride; and Sb group (n = 32), 5 ml/kg 5% sodium bicarbonate. Cardiac output (CO), systolic blood pressure, mean arterial pressure (MAP), body temperature, heart rate, respiratory rate and blood gases were measured.

Results

There were no differences among the three groups in CO, MAP, heart rate or respiratory rate during the 120 min trial or the 8 hour follow-up, and no significant differences in observed mortality rate after 28 days. However, improvement of MAP and CO started earlier in the Sb group than in the Ns and Hs groups. Sodium bicarbonate increased the base excess but did not alter blood pH, lactic acid or [HCO₃]^- values; and neither 3.5% hypertonic saline nor 5% sodium bicarbonate altered the Na⁺, K⁺, Ca²⁺ or Cl^- levels.

Conclusion

All three crystalloid solutions may be used for initial volume loading in severe sepsis, and sodium bicarbonate confers a limited benefit on humans with severe sepsis.

Trial registration

ISRCTN36748319.