Acute haemodynamic effects of a hypertonic saline/dextran solution in stable patients with severe sepsis

Objective: To study the haemodynamic effects of a hypertonic saline/dextran solution compared with a normal saline solution in patients with severe sepsis. Design: Prospective double blind and control-randomised study. Setting: Adult intensive care unit in a university hospital. Patients: Twenty-nine patients with sepsis with a pulmonary artery occlusion pressure (PAOP) lower than 12 mmHg. Interventions: Patients were randomised to receive 250 ml of blinded solutions of either normal saline (SS group, n=16) or hypertonic saline (NaCl 7.5%)/dextran 70 8% (HSS group, n=13) solutions. Measurements and results: Haemodynamic, blood gas, and sodium data were collected at the following time points: baseline, 30 min, 60 min, 120 min, and 180 min. PAOP was higher in the HSS group at 30 min (10.7 +/- 3.2 mmHg vs 6.8 +/- 3.2 mmHg) and 60 min (10.3 +/- 3 mmHg vs 7.4 +/- 2.9 mmHg); P<0.05. The cardiac index increased in the HSS group and it was greater than the SS group at 30 min (6.5 +/- 4.7 1 min(-1) m(-2) vs 3.8 +/- 3.4 1 min(-1) m(-2)), 60 min (4.9 +/- 4.5 1 min(-1) m(-2) vs 3.7 +/- 3.3 1 min(-1) m(-2)), and 120 min (5.0 +/- 4.3 1 min(-1) m(-2) vs 4.1 +/- 3.4 1 min(-1) m(-2)); P<0.05. The stroke volume index followed a comparable course and it was higher at 30 min [53.6(39.2-62.8) ml m(-2) vs 35.6(31.2-49.2) ml m(-2)] and 60 min [46.8(39.7-56.6) ml m(-2) vs 33.9(32.2-47.7) ml m(-2)]; P<0.05. Systemic vascular resistance decreased in the HSS group and became significantly lower at 30 min (824 +/- 277 dyne s(-1) cm(-5) m(-2) vs 1139 +/- 245 dyne s(-1) cm(-5) m(-2)), 60 min (921 +/- 256 dyne s(-1) cm(-5) m(-2) vs 1246 +/- 308 dyne s(-1) cm(-5) m(-2)), and 120 min (925 +/- 226 dyne s(-1) cm(-5) m(-2) vs 1269 +/- 494 dyne s(-1) cm(-5) m(-2)). Sodium levels increased in the HSS group (P=0.056) and were higher than in the SS group at 30 min (145 +/- 3 mEq l(-1) vs 137 +/- 7 mEq l(-1)), 60 min (143 +/- 4 mEq l(-1) vs 136 7 mEq l(-1)), 120 (142 5 mEq l(-1) vs 136 +/- 7 mEq l(-1)), and 180 min (142 +/- 5 mEq l(-1) vs 136 +/- 8 mEq l(-1)). Conclusion: Hypertonic saline/dextran solution may improve cardiovascular performance in severe sepsis without significant side effects. The haemodynamic effect appears related mainly to a volume effect.