Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 18, 3010, Bern, Switzerland.
Department of Cardiovascular Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
Intensive Care Med. 2020 Sep;46(9):1683-1695. doi: 10.1007/s00134-020-06132-0. Epub 2020 Jun 9.
Recent evidence questions a liberal approach to fluid resuscitation in intensive care unit (ICU) patients. Here, we assess whether use of hypertonic saline applied as single infusion at ICU admission after cardiac surgery can reduce cumulative perioperative fluid volume.
Prospective randomized double-blind single-center clinical trial investigates effects of a single infusion of hypertonic saline (HS) versus normal saline (comparator). Primary endpoint was the cumulative amount of fluid administered in patients in the hypertonic saline versus the 0.9% saline groups (during ICU stay). Upon ICU admission, patients received a single infusion of 5 ml/kg body weight of 7.3% NaCl (or 0.9% NaCl) over 60 min. Patients undergoing cardiac surgery for elective valvular and/or coronary heart disease were included. Patients with advanced organ dysfunction, infection, and/or patients on chronic steroid medication were excluded.
A total of 101 patients were randomized to receive the study intervention (HS n = 53, NS n = 48). Cumulative fluid intake on the ICU (primary endpoint) did not differ between the HS and the NS groups [median 3193 ml (IQR 2052-4333 ml) vs. 3345 ml (IQR 2332-5043 ml)]. Postoperative urinary output until ICU discharge was increased in HS-treated patients [median 2250 ml (IQR 1640-2690 ml) vs. 1545 ml (IQR 1087-1976 ml)], and ICU fluid balance was lower in the HS group when compared to the NS group [296 ml (IQR - 441 to 1412 ml) vs. 1137 ml (IQR 322-2660 ml)].
In a monocentric prospective double-blind randomized clinical trial, we observed that hypertonic saline did not reduce the total fluid volume administered on the ICU in critically ill cardiac surgery patients. Hypertonic saline infusion was associated with timely increase in urinary output. Variations in electrolyte and acid-base homeostasis were transient, but substantial in all patients.
最近的证据对重症监护病房（ICU）患者进行自由液体复苏的方法提出了质疑。在这里，我们评估心脏手术后 ICU 入院时单次输注高渗盐水（HS）是否可以减少围手术期累积液体量。
前瞻性随机双盲单中心临床试验调查了 HS 与生理盐水（对照）单次输注的效果。主要终点是 HS 组与 0.9%生理盐水组患者在 ICU 期间接受的累积液体量。ICU 入院时，患者接受 5ml/kg 体重 7.3%NaCl（或 0.9%NaCl）输注 60 分钟。纳入接受择期瓣膜和/或冠心病心脏手术的患者。排除晚期器官功能障碍、感染和/或长期类固醇治疗的患者。
共有 101 名患者被随机分配接受研究干预（HS 组 n=53，NS 组 n=48）。HS 和 NS 组 ICU 内累积液体摄入（主要终点）无差异[中位数 3193ml（IQR 2052-4333ml）vs. 3345ml（IQR 2332-5043ml）]。HS 治疗患者术后至 ICU 出院的尿量增加[中位数 2250ml（IQR 1640-2690ml）vs. 1545ml（IQR 1087-1976ml）]，HS 组 ICU 液体平衡低于 NS 组[296ml（IQR -441 至 1412ml）vs. 1137ml（IQR 322-2660ml）]。
在一项单中心前瞻性双盲随机临床试验中，我们观察到高渗盐水并未减少危重心血管手术患者 ICU 上的总液体量。高渗盐水输注与及时增加尿量有关。所有患者的电解质和酸碱平衡变化都是短暂的，但变化很大。
