Combined fluid and corticosteroid therapy in septic shock in puppies.

Abstract

AbstractThe optimal treatment of septic shock remains controversial. In order to evaluate the efficacy of fluid resuscitation and corticosteroid administration, the following experimental study was undertaken. Forty‐five puppies (1.6–5.4 kg) were randomly divided into 9 groups generated by combining 3 different fluid regimens and 3 different timings for steroid administration. Arterial, venous, and pulmonary artery catheterization allowed continuous hemodynamic and metabolic monitoring. Septic shock was achieved by a slow bolus infusion of 109/kgEscherichia coli organisms. Methylprednisolone (30 mg/kg) was administered either 30 min before bacterial infusion, at the time of shock, or 30 min after shock. When cardiac output dropped to less than 50% of control values, 1 of the 3 following fluid resuscitation regimens was begun: 5% albumin in lactated Ringer's (LR) at 35% of the estimated blood volume (EBV), LR at 105% EBV, or 5% albumin in LR at 105% EBV.When all the groups were combined, early steroid treatment was more effective than delayed therapy, yielding respective survival rates of 47% and 7% at 180 min. Similarly, the large‐volume resuscitation groups achieved a 43% survival rate compared to 13% for the smaller fluid protocols. Neither early steroid therapy nor large volume fluid therapy was shown by itself to increase survival, however. Despite steroid pretreatment, none of the puppies given the lower‐volume infusion survived. Also, despite large‐volume fluid resuscitation, there were no survivors when this was combined with steroid treatment that was delayed 30 min. Only by combining early steroid administration with large‐volume fluid therapy was a markedly increased survival rate achieved: 60% with simultaneous steroid treatment, and 70% with steroid pretreatment.A definite increase in animal survival has, therefore, been shown in the acute period of severe septic shock using a combination of high‐volume fluid resuscitation and the early administration of steroids.