Petroni Ricardo Costa, Biselli Paolo Jose Cesare, Lima Thais Martins de, Velasco Irineu Tadeu, Soriano Francisco Garcia
Emergency Medicine Department (LIM51), Medical School, University of Sao Paulo, Sao Paulo, Brazil.
Shock. 2015 Dec;44(6):609-15. doi: 10.1097/SHK.0000000000000461.
Acute lung injury (ALI) is a common complication associated with septic shock that directly influences the prognosis of sepsis patients. Currently, one of the main supportive treatment modalities for septic shock is fluid resuscitation. The use of hypertonic saline (HS: 7.5% NaCl) for fluid resuscitation has been described as a promising therapy in experimental models of sepsis-induced ALI, but it has failed to produce similar results in clinical practice. Thus, we compared experimental timing versus clinical timing effectiveness (i.e., early vs. late fluid resuscitation) after the inflammatory scenario was established in a rat model of bacterial lipopolysaccharide-induced ALI. We found that late fluid resuscitation with hypertonic saline (NaCl 7.5%) did not reduce the mortality rates of animals compared with the mortality late associated with early treatment. Late fluid resuscitation with both hypertonic and normal saline increased pulmonary inflammation, decreased pulmonary function, and induced pulmonary injury by elevating metalloproteinase-2 and metalloproteinase-9 activity and collagen deposition in the animals, unlike early treatment. The animals with lipopolysaccharide-induced ALI that received late resuscitation with any kind of fluids demonstrated aggravated pulmonary injury and respiratory function. Moreover, we showed that the therapeutic window for a beneficial effect of fluid resuscitation with hypertonic saline is very narrow.
急性肺损伤（ALI）是脓毒性休克常见的并发症，直接影响脓毒症患者的预后。目前，脓毒性休克主要的支持性治疗方式之一是液体复苏。在脓毒症诱导的急性肺损伤实验模型中，使用高渗盐水（HS：7.5%氯化钠）进行液体复苏已被描述为一种有前景的治疗方法，但在临床实践中未能产生类似结果。因此，我们在细菌脂多糖诱导的急性肺损伤大鼠模型中，比较了在炎症状态建立后实验性时机与临床时机的有效性（即早期与晚期液体复苏）。我们发现，与早期治疗相关的晚期死亡率相比，用高渗盐水（7.5%氯化钠）进行晚期液体复苏并未降低动物的死亡率。与早期治疗不同，用高渗盐水和生理盐水进行晚期液体复苏均会增加肺部炎症、降低肺功能，并通过提高动物体内金属蛋白酶-2和金属蛋白酶-9的活性以及胶原沉积来诱导肺损伤。接受任何一种液体晚期复苏的脂多糖诱导的急性肺损伤动物均表现出加重的肺损伤和呼吸功能。此外，我们表明，高渗盐水液体复苏产生有益效果的治疗窗口非常狭窄。
