Bolus therapy with 3% hypertonic saline or 0.9% saline in emergency department patients with suspected sepsis: A pilot randomised controlled trial

Research output: Contribution to journalArticle

Abstract

Objective and design: Hypertonic saline administered during fluid resuscitation may mitigate endothelial glycocalyx (EG) shedding and inflammation. The objective of this pilot randomised controlled trial was to measure the effect of hypertonic saline, compared to isotonic saline, on biomarkers of EG shedding and inflammation in emergency department patients with suspected sepsis. Methods: Patients received either 5 mL/kg of 3% saline (hypertonic group, n = 34) or 10 mL/kg of 0.9% saline (isotonic group, n = 31). Change in serum biomarker concentrations of syndecan-1, hyaluronan, intercellular adhesion molecule-1, vascular cell adhesion molecule-1, interleukin-6, -8, -10, interferon-γ, neutrophil gelatinase-associated lipocalin and resistin were compared from baseline (T0) to after fluid (T1), 3 h (T3) and 12–24 h (T24) later, as was serum osmolality, using linear mixed effects models. Results: The hypertonic group had significantly increased mean serum osmolality compared to the isotonic group at T1 (P <.001) and T3 (P =.004). Minor differences were found in some biomarker outcomes, including a decreased fold-change in syndecan-1 at T1 (P =.012) and in interleukin-10 at T24 (P =.006) in the isotonic group, compared to the hypertonic group. Conclusions: Although a single bolus of hypertonic saline increased serum osmolality, it did not reduce biomarkers of EG shedding or inflammation, compared to patients that received isotonic saline. Trial registration: ANZCTR.org.au, ACTRN12611001021965, Registered on 23rd September 2011.

Original languageEnglish
Pages (from-to)33-39
Number of pages7
JournalJournal of Critical Care
Volume52
Early online date28 Mar 2019
DOIs
Publication statusE-pub ahead of print - 28 Mar 2019

Fingerprint

Glycocalyx
Hospital Emergency Service
Sepsis
Randomized Controlled Trials
Biomarkers
Syndecan-1
Osmolar Concentration
Inflammation
Serum
Resistin
Vascular Cell Adhesion Molecule-1
Intercellular Adhesion Molecule-1
Hyaluronic Acid
Therapeutics
Interleukin-8
Resuscitation
Interleukin-10
Interferons
Interleukin-6
3-monoiodothyronine

Cite this

@article{d7bc9e4efdcd4d14a655b8b640bde50c,
title = "Bolus therapy with 3{\%} hypertonic saline or 0.9{\%} saline in emergency department patients with suspected sepsis: A pilot randomised controlled trial",
abstract = "Objective and design: Hypertonic saline administered during fluid resuscitation may mitigate endothelial glycocalyx (EG) shedding and inflammation. The objective of this pilot randomised controlled trial was to measure the effect of hypertonic saline, compared to isotonic saline, on biomarkers of EG shedding and inflammation in emergency department patients with suspected sepsis. Methods: Patients received either 5 mL/kg of 3{\%} saline (hypertonic group, n = 34) or 10 mL/kg of 0.9{\%} saline (isotonic group, n = 31). Change in serum biomarker concentrations of syndecan-1, hyaluronan, intercellular adhesion molecule-1, vascular cell adhesion molecule-1, interleukin-6, -8, -10, interferon-γ, neutrophil gelatinase-associated lipocalin and resistin were compared from baseline (T0) to after fluid (T1), 3 h (T3) and 12–24 h (T24) later, as was serum osmolality, using linear mixed effects models. Results: The hypertonic group had significantly increased mean serum osmolality compared to the isotonic group at T1 (P <.001) and T3 (P =.004). Minor differences were found in some biomarker outcomes, including a decreased fold-change in syndecan-1 at T1 (P =.012) and in interleukin-10 at T24 (P =.006) in the isotonic group, compared to the hypertonic group. Conclusions: Although a single bolus of hypertonic saline increased serum osmolality, it did not reduce biomarkers of EG shedding or inflammation, compared to patients that received isotonic saline. Trial registration: ANZCTR.org.au, ACTRN12611001021965, Registered on 23rd September 2011.",
keywords = "Crystalloid fluids, Endothelium, Inflammation, Sepsis",
author = "Lisa Smart and Macdonald, {Stephen P.J.} and Erika Bosio and Daniel Fatovich and Claire Neil and Glenn Arendts",
year = "2019",
month = "3",
day = "28",
doi = "10.1016/j.jcrc.2019.03.009",
language = "English",
volume = "52",
pages = "33--39",
journal = "Journal of Critical Care",
issn = "0883-9441",
publisher = "Saunders",

}

TY - JOUR

T1 - Bolus therapy with 3% hypertonic saline or 0.9% saline in emergency department patients with suspected sepsis

T2 - A pilot randomised controlled trial

AU - Smart, Lisa

AU - Macdonald, Stephen P.J.

AU - Bosio, Erika

AU - Fatovich, Daniel

AU - Neil, Claire

AU - Arendts, Glenn

PY - 2019/3/28

Y1 - 2019/3/28

N2 - Objective and design: Hypertonic saline administered during fluid resuscitation may mitigate endothelial glycocalyx (EG) shedding and inflammation. The objective of this pilot randomised controlled trial was to measure the effect of hypertonic saline, compared to isotonic saline, on biomarkers of EG shedding and inflammation in emergency department patients with suspected sepsis. Methods: Patients received either 5 mL/kg of 3% saline (hypertonic group, n = 34) or 10 mL/kg of 0.9% saline (isotonic group, n = 31). Change in serum biomarker concentrations of syndecan-1, hyaluronan, intercellular adhesion molecule-1, vascular cell adhesion molecule-1, interleukin-6, -8, -10, interferon-γ, neutrophil gelatinase-associated lipocalin and resistin were compared from baseline (T0) to after fluid (T1), 3 h (T3) and 12–24 h (T24) later, as was serum osmolality, using linear mixed effects models. Results: The hypertonic group had significantly increased mean serum osmolality compared to the isotonic group at T1 (P <.001) and T3 (P =.004). Minor differences were found in some biomarker outcomes, including a decreased fold-change in syndecan-1 at T1 (P =.012) and in interleukin-10 at T24 (P =.006) in the isotonic group, compared to the hypertonic group. Conclusions: Although a single bolus of hypertonic saline increased serum osmolality, it did not reduce biomarkers of EG shedding or inflammation, compared to patients that received isotonic saline. Trial registration: ANZCTR.org.au, ACTRN12611001021965, Registered on 23rd September 2011.

AB - Objective and design: Hypertonic saline administered during fluid resuscitation may mitigate endothelial glycocalyx (EG) shedding and inflammation. The objective of this pilot randomised controlled trial was to measure the effect of hypertonic saline, compared to isotonic saline, on biomarkers of EG shedding and inflammation in emergency department patients with suspected sepsis. Methods: Patients received either 5 mL/kg of 3% saline (hypertonic group, n = 34) or 10 mL/kg of 0.9% saline (isotonic group, n = 31). Change in serum biomarker concentrations of syndecan-1, hyaluronan, intercellular adhesion molecule-1, vascular cell adhesion molecule-1, interleukin-6, -8, -10, interferon-γ, neutrophil gelatinase-associated lipocalin and resistin were compared from baseline (T0) to after fluid (T1), 3 h (T3) and 12–24 h (T24) later, as was serum osmolality, using linear mixed effects models. Results: The hypertonic group had significantly increased mean serum osmolality compared to the isotonic group at T1 (P <.001) and T3 (P =.004). Minor differences were found in some biomarker outcomes, including a decreased fold-change in syndecan-1 at T1 (P =.012) and in interleukin-10 at T24 (P =.006) in the isotonic group, compared to the hypertonic group. Conclusions: Although a single bolus of hypertonic saline increased serum osmolality, it did not reduce biomarkers of EG shedding or inflammation, compared to patients that received isotonic saline. Trial registration: ANZCTR.org.au, ACTRN12611001021965, Registered on 23rd September 2011.

KW - Crystalloid fluids

KW - Endothelium

KW - Inflammation

KW - Sepsis

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U2 - 10.1016/j.jcrc.2019.03.009

DO - 10.1016/j.jcrc.2019.03.009

M3 - Article

VL - 52

SP - 33

EP - 39

JO - Journal of Critical Care

JF - Journal of Critical Care

SN - 0883-9441

ER -