Department of Anesthesiology and Surgical Intensive Care Unit, Brest University Hospital, Brest, France.
Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia.
Shock. 2021 Sep 1;56(3):425-432. doi: 10.1097/SHK.0000000000001757.
Fluid administration is one of the first lines of treatment for hemodynamic management of sepsis and septic shock. Studies investigating the effects of chloride-rich fluids including normal saline on renal function report controversial findings.
This is a prospective, observational, multicenter study. Patients with septic shock, defined according to Sepsis-2 definition, were eligible. A "high-dose" of chloride was defined as a chloride intake greater than 18 g administrated within the first 48 h of septic shock management. The purpose of this study was to investigate the impact of cumulative chloride infusion within the first 48 h of septic shock resuscitation on acute kidney injury (AKI).
Two hundred thirty-nine patients with septic shock were included. Patients who received a "high-dose" of chloride had significantly higher Sequential Organ Failure Assessment score at the time of enrolment (P < 0.001). Cumulative chloride load was higher in patients requiring renal replacement therapy (RRT) (31.1 vs. 25.2 g/48 h; P < 0.005). Propensity score-weighted regression did not find any association between "high-dose" of chloride and AKI requiring RRT (OR: 0.97 [0.88-1.1]; P = 0.69). There was no association between "high-dose" of chloride and worsening kidney function at H48 (OR: 0.94 [0.83-1.1]; P = 0.42). There was also no association between "high-dose" of chloride and ICU length of stay (P = 0.61), 28-day mortality (P = 0.83), or hospital mortality (P = 0.89).
At the early stage of resuscitation of critically ill patients with septic shock, administration of "high-dose" of chloride (> 18 g/48 h) was not associated with renal prognosis.
在脓毒症和脓毒性休克的血流动力学管理中，输液是治疗的首要措施之一。研究表明，富含氯的液体（包括生理盐水）对肾功能的影响存在争议。
这是一项前瞻性、观察性、多中心研究。入选的患者符合脓毒症-2 定义的脓毒性休克。“高剂量”氯的定义为在脓毒性休克管理的前 48 小时内输注大于 18g 的氯。本研究旨在探讨脓毒性休克复苏的前 48 小时内累积氯输注量对急性肾损伤（AKI）的影响。
共纳入 239 例脓毒性休克患者。接受“高剂量”氯的患者在入组时的序贯器官衰竭评估（SOFA）评分显著更高（P<0.001）。需要肾脏替代治疗（RRT）的患者累积氯负荷更高（31.1 比 25.2g/48h；P<0.005）。倾向评分加权回归未发现“高剂量”氯与需要 RRT 的 AKI 之间存在任何关联（比值比：0.97[0.88-1.1]；P=0.69）。“高剂量”氯与 H48 时肾功能恶化之间也没有关联（比值比：0.94[0.83-1.1]；P=0.42）。“高剂量”氯与 ICU 住院时间（P=0.61）、28 天死亡率（P=0.83）或住院死亡率（P=0.89）也无关联。
在严重脓毒性休克患者复苏的早期阶段，给予“高剂量”氯（>18g/48h）与肾脏预后无关。
