Abstract: Poster Presentations |


Massimiliano Guglielmi, MD*; Sergio Zanotti, MD; Walker Tracy, MD; Magali Zanotti, BA; Felicitas Ross, BA; Joseph E. Parrillo, MD; Steven M. Hollenberg, MD
Author and Funding Information

Cooper University hospital/UMDNJ, Camden, NJ


Chest. 2005;128(4_MeetingAbstracts):290S. doi:10.1378/chest.128.4_MeetingAbstracts.290S
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PURPOSE:  Fluid resuscitation and antibiotic administration are critical components of the early treatment of sepsis. We evaluated the impact of three different early resuscitation regimens on cardiac performance in a murine model of sepsis.

METHODS:  3 groups of 8 C57Bl/6 mice were made septic by cecal ligation and double perforation (CLP); 5 controls had sham ligation. After CLP animals received 1 of 3 fluid regimens: 35mL/kg normal saline bolus SQ after surgery only (None), 35mL/kg after surgery and then every 6hr, (Partial) and 100mL/kg after surgery and then every 6hr (Full). All 3 groups received ceftriaxone, 30mg/kg and clindamycin, 25mg/kg at 6 and 12hr. Animals were anesthetized briefly with isoflurane for echocardiography using a high-resolution ultrasound system (30Mhz scan-head). Stroke volume (SV, μL) was assessed by Doppler in the aortic outflow tract and fractional shortening (FS, %) by M-mode in the short axis view. Cardiac output (CO, mL/min) was calculated as SV*HR.

RESULTS:  From 3 to 9hr after CLP, CO was reduced from 25±2 to 13±2 (None), 24±4 to 15±5 (Partial) and 26±5 to 17±4mL/min (Full), largely due to a reduction in SV, from 56±6 to 23±2 (None), 51±6 to 28±7 (Partial), and 58±7 to 32±5μL; (Full) (p<0.05 vs baseline and sham operated animals in all groups. Heart rate did not change significantly. Animals that received aggressive resuscitation (Full) reached a normodynamic state at 15hours, CO 23±7; SV 48±9; HR 475±74, p=NS vs baseline and sham operated animals. Unresuscitated and underresuscitated animals remained in a hypodynamic state, CO 14±6; SV 30±10; HR 470±50 (None) and CO 15±3; SV 40±9; 395±35 (Partial), p<0.05 vs baseline, sham operated and aggressively resuscitated animals (Full).

CONCLUSION:  Adequate fluid resuscitation is mandatory to restore a normodynamic state in sepsis. In this murine model, which replicates clinical sepsis, early underresuscitation can lead to a sustained hypodynamic state. Early and aggressive resuscitation is necessary to reestablish normal hemodynamics.

CLINICAL IMPLICATIONS:  Even seemingly minor degrees of underresuscitation early could potentially impair hemodynamics in later phases of sepsis in patients.

DISCLOSURE:  Massimiliano Guglielmi, University grant monies.

Wednesday, November 2, 2005

12:30 PM - 2:00 PM




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