Journal article
Fluid resuscitation with 0.9% saline alters haemostasis in an ovine model of endotoxemic shock
Thrombosis Research, Vol.176, pp.39-45
2019
Abstract
Introduction: Fluid resuscitation is a cornerstone of severe sepsis management, however there are many uncertainties surrounding the type and volume of fluid that is administered. The entire spectrum of coagulopathies can be seen in sepsis, from asymptomatic aberrations to fulminant disseminated intravascular coagulation (DIC). The aim of this study was to determine if fluid resuscitation with saline contributes to the haemostatic derangements in an ovine model of endotoxemic shock. Materials and methods: Twenty-one adult female sheep were randomly divided into no endotoxemia (n = 5) or endotoxemia groups (n = 16) with an escalating dose of lipopolysaccharide (LPS) up to 4 μg/kg/h administered to achieve a mean arterial pressure below 60 mmHg. Endotoxemia sheep received either no bolus fluid resuscitation (n = 8) or a 0.9% saline bolus (40 mL/kg over 60 min) (n = 8). No endotoxemia, saline only animals (n = 5) underwent fluid resuscitation with a 0.9% bolus of saline as detailed above. Hemodynamic support with vasopressors was initiated if needed, to maintain a mean arterial pressure (MAP) of 60-65 mm Hg in all the groups. Results: Rotational thromboelastometry (ROTEM®) and conventional coagulation biomarker tests demonstrated sepsis induced derangements to secondary haemostasis. This effect was exacerbated by saline fluid resuscitation, with low pH (p = 0.036), delayed clot initiation and formation together with deficiencies in naturally occurring anti-coagulants antithrombin (p = 0.027) and Protein C (p = 0.001). Conclusions: Endotoxemia impairs secondary haemostasis and induces changes in the intrinsic, extrinsic and anti-coagulant pathways. These changes to haemostasis are exacerbated following resuscitation with 0.9% saline, a commonly used crystalloid in clinical settings.
Details
- Title
- Fluid resuscitation with 0.9% saline alters haemostasis in an ovine model of endotoxemic shock
- Authors
- Margaret R Passmore (Author) - University of QueenslandNchafatso G Obonyo (Author) - KEMRI-Wellcome Trust Research Programme, KenyaLiam Byrne (Author) - Canberra HospitalAi-Ching Boon (Author) - Prince Charles HospitalSara D Diab (Author) - Prince Charles HospitalKimble R Dunster (Author) - Prince Charles HospitalYoke Lin Fung (Author) - University of the Sunshine Coast - School of Health and Sports SciencesMichelle M Spanevello (Author) - University of QueenslandMohd H Fauzi (Author) - Universiti Sains Malaysia Health Campus, MalaysiaSanne E Pedersen (Author) - Prince Charles HospitalGabriela Simonova (Author) - Prince Charles HospitalChris M Anstey (Author) - Prince Charles HospitalKiran Shekar (Author) - Prince Charles HospitalJohn-Paul Tung (Author) - Prince Charles HospitalKathryn Maitland (Author) - Imperial College London, United KingdomJohn F Fraser (Author) - University of Queensland
- Publication details
- Thrombosis Research, Vol.176, pp.39-45
- Publisher
- Pergamon
- Date published
- 2019
- DOI
- 10.1016/j.thromres.2019.02.015
- ISSN
- 0049-3848
- Copyright note
- Copyright © 2019. This manuscript version is made available under the CC-BY-NC-ND 4.0 license http://creativecommons.org/licenses/by-nc-nd/4.0/
- Organisation Unit
- School of Health - Biomedicine; University of the Sunshine Coast, Queensland; School of Health and Sport Sciences - Legacy; School of Health and Behavioural Sciences - Legacy
- Language
- English
- Record Identifier
- 99451500402621
- Output Type
- Journal article
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- Domestic collaboration
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- Hematology
- Peripheral Vascular Disease
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