Abstract
Objectives: To examine the effects of fluid bolus therapy on systemic hemodynamics, renal blood flow, intrarenal perfusion and oxygenation, Po 2 , renal function, and fluid balance in experimental early septic acute kidney injury. Design: Interventional study. Setting: Research institute. Subjects: Adult Merino ewes. Interventions: Implantation of flow probes on the pulmonary and renal arteries and laser Doppler oxygen-sensing probes in the renal cortex, medulla, and within a bladder catheter in sheep. Infusion of Escherichia coli to induce septic acute kidney injury (n = 8). After 24, 25, and 26 hours of sepsis, fluid bolus therapy (500 mL of Hartmann's solution over 15 min) was administered. Measurements and Main Results: In conscious sheep, infusion of Escherichia coli decreased creatinine clearance and increased plasma creatinine, renal blood flow (+46% ± 6%) and cortical perfusion (+25% ± 4%), but medullary perfusion (-48% ± 5%), medullary Po 2 (-56% ± 4%), and urinary Po 2 (-54% ± 3%) decreased (p < 0.01). The first fluid bolus therapy increased blood pressure (+6% ± 1%), central venous pressure (+245% ± 65%), cardiac output (+11% ± 2%), medullary Po 2 (+280% ± 90%), urinary Po 2 (+164% ± 80%), and creatinine clearance (+120% ± 65%) at 30 minutes. The following two boluses had no beneficial effects on creatinine clearance. The improvement in medullary oxygenation dissipated following the third fluid bolus therapy. Study animals retained 69% of the total volume and 80% of sodium infused. Throughout the study, urinary Po 2 correlated significantly with medullary Po 2 . Conclusions: In early experimental septic acute kidney injury, fluid bolus therapy transiently improved renal function and medullary Po 2 , as also reflected by increased urinary Po 2. These initial effects of fluid bolus therapy dissipated within 4 hours, despite two additional fluid boluses, and resulted in significant volume retention.
| Original language | English |
|---|---|
| Pages (from-to) | E36-E43 |
| Journal | Critical care medicine |
| Volume | 47 |
| Issue number | 1 |
| DOIs | |
| Publication status | Published - Jan 1 2019 |
| Externally published | Yes |
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Keywords
- acute kidney injury
- fluid bolus therapy
- hypoxia
- sepsis
ASJC Scopus subject areas
- Critical Care and Intensive Care Medicine
Cite this
Effects of Fluid Bolus Therapy on Renal Perfusion, Oxygenation, and Function in Early Experimental Septic Kidney Injury. / Lankadeva, Yugeesh R.; Kosaka, Junko; Iguchi, Naoya; Evans, Roger G.; Booth, Lindsea C.; Bellomo, Rinaldo; May, Clive N.
In: Critical care medicine, Vol. 47, No. 1, 01.01.2019, p. E36-E43.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Effects of Fluid Bolus Therapy on Renal Perfusion, Oxygenation, and Function in Early Experimental Septic Kidney Injury
AU - Lankadeva, Yugeesh R.
AU - Kosaka, Junko
AU - Iguchi, Naoya
AU - Evans, Roger G.
AU - Booth, Lindsea C.
AU - Bellomo, Rinaldo
AU - May, Clive N.
PY - 2019/1/1
Y1 - 2019/1/1
N2 - Objectives: To examine the effects of fluid bolus therapy on systemic hemodynamics, renal blood flow, intrarenal perfusion and oxygenation, Po 2 , renal function, and fluid balance in experimental early septic acute kidney injury. Design: Interventional study. Setting: Research institute. Subjects: Adult Merino ewes. Interventions: Implantation of flow probes on the pulmonary and renal arteries and laser Doppler oxygen-sensing probes in the renal cortex, medulla, and within a bladder catheter in sheep. Infusion of Escherichia coli to induce septic acute kidney injury (n = 8). After 24, 25, and 26 hours of sepsis, fluid bolus therapy (500 mL of Hartmann's solution over 15 min) was administered. Measurements and Main Results: In conscious sheep, infusion of Escherichia coli decreased creatinine clearance and increased plasma creatinine, renal blood flow (+46% ± 6%) and cortical perfusion (+25% ± 4%), but medullary perfusion (-48% ± 5%), medullary Po 2 (-56% ± 4%), and urinary Po 2 (-54% ± 3%) decreased (p < 0.01). The first fluid bolus therapy increased blood pressure (+6% ± 1%), central venous pressure (+245% ± 65%), cardiac output (+11% ± 2%), medullary Po 2 (+280% ± 90%), urinary Po 2 (+164% ± 80%), and creatinine clearance (+120% ± 65%) at 30 minutes. The following two boluses had no beneficial effects on creatinine clearance. The improvement in medullary oxygenation dissipated following the third fluid bolus therapy. Study animals retained 69% of the total volume and 80% of sodium infused. Throughout the study, urinary Po 2 correlated significantly with medullary Po 2 . Conclusions: In early experimental septic acute kidney injury, fluid bolus therapy transiently improved renal function and medullary Po 2 , as also reflected by increased urinary Po 2. These initial effects of fluid bolus therapy dissipated within 4 hours, despite two additional fluid boluses, and resulted in significant volume retention.
AB - Objectives: To examine the effects of fluid bolus therapy on systemic hemodynamics, renal blood flow, intrarenal perfusion and oxygenation, Po 2 , renal function, and fluid balance in experimental early septic acute kidney injury. Design: Interventional study. Setting: Research institute. Subjects: Adult Merino ewes. Interventions: Implantation of flow probes on the pulmonary and renal arteries and laser Doppler oxygen-sensing probes in the renal cortex, medulla, and within a bladder catheter in sheep. Infusion of Escherichia coli to induce septic acute kidney injury (n = 8). After 24, 25, and 26 hours of sepsis, fluid bolus therapy (500 mL of Hartmann's solution over 15 min) was administered. Measurements and Main Results: In conscious sheep, infusion of Escherichia coli decreased creatinine clearance and increased plasma creatinine, renal blood flow (+46% ± 6%) and cortical perfusion (+25% ± 4%), but medullary perfusion (-48% ± 5%), medullary Po 2 (-56% ± 4%), and urinary Po 2 (-54% ± 3%) decreased (p < 0.01). The first fluid bolus therapy increased blood pressure (+6% ± 1%), central venous pressure (+245% ± 65%), cardiac output (+11% ± 2%), medullary Po 2 (+280% ± 90%), urinary Po 2 (+164% ± 80%), and creatinine clearance (+120% ± 65%) at 30 minutes. The following two boluses had no beneficial effects on creatinine clearance. The improvement in medullary oxygenation dissipated following the third fluid bolus therapy. Study animals retained 69% of the total volume and 80% of sodium infused. Throughout the study, urinary Po 2 correlated significantly with medullary Po 2 . Conclusions: In early experimental septic acute kidney injury, fluid bolus therapy transiently improved renal function and medullary Po 2 , as also reflected by increased urinary Po 2. These initial effects of fluid bolus therapy dissipated within 4 hours, despite two additional fluid boluses, and resulted in significant volume retention.
KW - acute kidney injury
KW - fluid bolus therapy
KW - hypoxia
KW - sepsis
UR - http://www.scopus.com/inward/record.url?scp=85058791977&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85058791977&partnerID=8YFLogxK
U2 - 10.1097/CCM.0000000000003507
DO - 10.1097/CCM.0000000000003507
M3 - Article
C2 - 30394921
AN - SCOPUS:85058791977
VL - 47
SP - E36-E43
JO - Critical Care Medicine
JF - Critical Care Medicine
SN - 0090-3493
IS - 1
ER -