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Abstract
Objectives: to investigate the therapeutic value of 3% hypertonic saline boluses in septic shock regarding the clinical course and final outcome, compared to routine resuscitation fluids. Design: A prospective, randomized, single center study. Setting: medical/surgical ICU (Ahmed Maher Teaching Hospital). Patients: 40 critically ill patients admitted to ICU with septic shock divided into two groups: group I received routine resuscitation fluids, group II received 2 boluses of 3% HTS on admission &12 hours later (4ml/kg at a rate <1ml/kg/min.) in addition to routine resuscitation fluids. Measurements: CRP concentrations (semi-quantitative measured by ELISA) were measured day 0, 1, 2 &7, Echo parameters as EF,FS&CO (day 0,1,2&7) to assess changes in myocardial contractility. APACHE II score was calculated on admission,MODS&SOFA scores calculated daily for 7 days.Survival and clinical outcome were recorded for all patients. Results:Hypertonic saline 3% could be used as an adjuvant resuscitation therapy with concurrent routine resuscitation protocols in septic shock as it has rapid and prolonged effects in improvement hemo-dynamics. It has significant anti-inflammatory effects as measured by significant decline of CRP in septic shock, Improvement of all cardiac functions and benign side effects as well. Conclusion: Hypertonic saline 3% has significant improvement in hemodynamics; inflammatory mediators; myocardial contractility;clinical course (ICU stay; mortality; need for MV, inotropes & vasopressors; progression of complications but this improvement is transient.