Abstract
The aim. Compare the hemodynamic effects and safety of infusion of the balanced crystalloid solution, sorbitol-based solution, and standard solution (0.9 % sodium chloride).
 Materials and methods. A prospective randomized clinical trial was carried out, the study included 68 adult patients, who had the active surgical infection, and were in a state of septic shock. A corresponding solution with a volume of 500 ml was used for resuscitation. Hemodynamic and other clinical and laboratory parameters were monitored.
 Results. There was no significant difference in mean arterial pressure (MAP) between the 3 groups before the 45th minute (p>0.05), from the 50th minute to 2 hours they were found only between the NS and Sorb groups (p <0.05). No statistically significant difference in heart rate (HR) was obtained in any measurement (p> 0.05). Cardiac output (CO) and oxygen delivery (DO2) did not differ until 35 min (p> 0.05) and up to 40 min (p> 0.05); after 40 min and 45 min, a significant difference was also found between the Sorb and NS groups (p <0.05). After infusion of a sorbitol-containing solution and a balanced polyionic solution, the acid-base state of the blood significantly improved. The applied dose of the sorbitol-containing solution was safe for renal function and blood clotting in septic shock in this study. But the applied balanced polyionic solution may be associated with a decrease in the number of platelets. Daily changes by APACHE II scores in each group were not statistically significant. The difference in 7-day and 28-day mortality between groups was not statistically significant (p>0.05).
 Conclusions. In our study, the balanced polyionic solution with 1.9 % sodium lactate and 6 % sorbitol was the most effective and safe infusion solution for the treatment of septic shock, it can be used as a supplement to balanced crystalloid solutions. When using a balanced polyionic solution (Ringer's acetate) with 0.07 % L-malonic acid, the platelet count should be monitored more often
Highlights
Infusion therapy is a key component of the treatment of septic shock [1]
The study did not include patients whose condition was recognized as incurable, as well as those who at the time of screening had already received a significant volume of infusion therapy (>1000 ml of solution for infusion) within the last 3 hours
Patients were randomized to one of the following groups: – Sorb group (Sorb. – Sorbitol): patients who received an intravenous infusion of 500 ml of balanced polion solution with 1.9 % sodium lactate and 6 % sorbitol; – Bal group (Bal. – balanced crystalloids): patients receiving an intravenous infusion of 500 ml of balanced polyionic solution (Ringer's acetate) with 0.07 % L-malonic acid; – NS group (NS – normal solution, control): patients received an intravenous infusion of 500 ml of 0.9 % sodium chloride solution
Summary
Fluid therapy is critical for improving cardiac output, restoring oxygen delivery, and preventing multiple organ failure syndrome (MODS) in septic shock [2]. When carrying out fluid resuscitation in septic shock, there is still no clear evidence of the advantage of any of the modern infusion solutions. In the International Guidelines for Management of Sepsis and Septic Shock 2016 [1], the authors recommend crystalloid solutions for initial resuscitation and circulating blood volume (CBV) support, but no recommendation is given on which specific crystalloid solution should be used, as no direct comparison of isotonic saline and balanced saline in patients with sepsis. It has been suggested to use albumin in addition to crystalloids for initial resuscitation and CBV support, provided that patients require significant amounts of crystalloids
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