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Bolus therapy with 3% hypertonic saline or 0.9% saline in emergency department patients with suspected sepsis: A pilot randomised controlled trial

Smart, L.ORCID: 0000-0003-4776-2849, Macdonald, S.P.J., Bosio, E., Fatovich, D., Neil, C. and Arendts, G. (2019) Bolus therapy with 3% hypertonic saline or 0.9% saline in emergency department patients with suspected sepsis: A pilot randomised controlled trial. Journal of Critical Care, 52 . pp. 33-39.

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Embargoed until March 2020.

Link to Published Version: https://doi.org/10.1016/j.jcrc.2019.03.009
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Abstract

Objective and design
Hypertonic saline administered during fluid resuscitation may mitigate endothelial glycocalyx (EG) shedding and inflammation. The objective of this pilot randomised controlled trial was to measure the effect of hypertonic saline, compared to isotonic saline on biomarkers of EG shedding and inflammation in emergency department patients with suspected sepsis.

Methods
Patients received either 5 mL/kg of 3% saline (hypertonic group, n = 34) or 10 mL/kg of 0.9% saline (isotonic group, n = 31). Serum biomarker concentrations of syndecan-1, hyaluronan, intercellular adhesion molecule-1, vascular cell adhesion molecule-1, interleukin-6, -8, -10, interferon-γ, neutrophil gelatinase-associated lipocalin and resistin were compared at baseline (T0), after fluid (T1), 3 h (T3) and 12–24 h (T24) later, as was serum osmolality, using linear mixed effects models.

Results
The hypertonic group had significantly increased mean serum osmolality compared to the isotonic group at T1 (P < .001) and T3 (P = .004). Minor differences were found in some biomarker outcomes, including a decreased fold-change in syndecan-1 at T1 (P = .012) and in interleukin-10 at T24 (P = .006) in the isotonic group, compared to the hypertonic group.

Conclusions
Although a single bolus of hypertonic saline increased serum osmolality, it did not reduce biomarkers of EG shedding or inflammation, compared to patients that received isotonic saline.

Item Type: Journal Article
Murdoch Affiliation: School of Veterinary and Life Sciences
Publisher: Elsevier B.V.
Copyright: © 2019 Elsevier Inc.
United Nations SDGs: Goal 3: Good Health and Well-Being
URI: http://researchrepository.murdoch.edu.au/id/eprint/44805
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