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  • Fluid resuscitation with 0.9% saline alters haemostasis in an ovine model of endotoxemic shock

    Author(s)
    Passmore, Margaret R
    Obonyo, Nchafatso G
    Byrne, Liam
    Boon, Ai-Ching
    Diab, Sara D
    Dunster, Kimble R
    Fung, Yoke L
    Spanevello, Michelle M
    Fauzi, Mohd H
    Pedersen, Sanne E
    Simonovah, Gabriela
    Anstey, Chris M
    Shekar, Kiran
    Tung, John-Paul
    Maitland, Kathryn
    Fraser, John F
    Griffith University Author(s)
    Anstey, Chris
    Year published
    2019
    Metadata
    Show full item record
    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 ...
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    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.
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    Journal Title
    Thrombosis Research
    Volume
    176
    DOI
    https://doi.org/10.1016/j.thromres.2019.02.015
    Subject
    Clinical sciences
    Publication URI
    http://hdl.handle.net/10072/385379
    Collection
    • Journal articles

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