Intérêt du mélange sérum salé hypertonique–hydroxyéthylamidon lors du choc hémorragique

Abstract

ObjectiveAssessment of haemodynamic, respiratory and renal effects of hypertonic saline–hydroxyethyl starch (HyperHES®) in critically ill-patients with hemorrhagic shock. Patients and methodsSeventeen mechanically ventilated patients with hemorragic shock benefiting from a cardiovascular monitoring by PiCCO device and requiring rapid volume loading. Two hundred and fifty milliliters of HyperHES® were given over 5minutes. The efficacy of volume loading was assessed by the measure of the systolic arterial pressure (SAP), cardiac index (CI), stroke volume variation (SVV) and the indexed systemic vascular resistance (iSVR). Studied parameters were assessed at baseline, 5, 30, 60 and 180minutes after the end of HyperHES® infusion. ResultsSAP (105±23 vs 77±10; p<0.001) and CI (4.8±1.1 vs 3.5±0.9; p<0.001) were significantly increased whereas iSVR (1175±310 vs 1501±337; p<0.01) and SVV (13±7 vs 20±5; p<0.01) were significantly decreased 5minutes after the HyperHES® infusion. Sodium (145±6 vs 136±5; p<0.001) and chloride (118±7 vs 107±6; p<0.001) were increased 5minutes after the infusion. The PaO2/FiO2 ratio as the extravascular lung water was not influenced by the infusion. The follow-up of renal parameters during the three first days (creatinemia, uremia and diuresis) did not revelead significant variations. ConclusionIn patients with hemorrhagic shock, the infusion of hypertonic saline (7.5%) hydroxyethyl starch association was followed by an increase in SAP, CI serum sodium and chloride concentrations. Study designProspective observational study.