Physiological response to fluid resuscitation with Ringer Lactate versus Plasmalyte in critically ill burn patients.

Solohaja Faniaha Dimby; Maïté Chaussard; François Dépret; Oriane Saint‐aubin; Mourad Benyamina; Maxime Coutrot; Marion Jully; Haikel Oueslati; Alexandre Fratani; Alexandru Cupaciu; Alicia Poniard; Karim Asehnoune; Alexandre Mebazaa; Pascal Houzé; Matthieu Legrand

Journal articles

Physiological response to fluid resuscitation with Ringer Lactate versus Plasmalyte in critically ill burn patients.

Solohaja Faniaha Dimby ^{1, 2} Maïté Chaussard ³ François Dépret ⁴ Oriane Saint‐aubin Mourad Benyamina ⁵ Maxime Coutrot Marion Jully Haikel Oueslati ⁶ Alexandre Fratani Alexandru Cupaciu Alicia Poniard Karim Asehnoune ⁷ Alexandre Mebazaa ² Pascal Houzé ⁸ Matthieu Legrand ^{2, 9}

1 SAMM - Statistique, Analyse et Modélisation Multidisciplinaire (SAmos-Marin Mersenne)

2 Groupe Hospitalier Saint Louis - Lariboisière - Fernand Widal [Paris]

3 Service d'Anesthésie et Soins Intensifs

4 F-CRIN, INICRCT network, Paris

5 Service d’anesthésie-réanimation [AP-HP Hôpital Saint-Louis]

6 Hôpital Saint-Louis

7 EA 3826 - Thérapeutiques cliniques et expérimentales des infections (EA 3826)

8 UTCBS - UM 4 (UMR 8258 / U1022) - Unité de Technologies Chimiques et Biologiques pour la Santé

9 Perioperative Clinical Research Core, Department of Anesthesia and Perioperative Care, UCSF Medical Center at Mt Zion

Abstract : The metabolic consequences in vivo of various balanced solutions are poorly known in critically ill patients. The main objective of this study was to describe the metabolic consequences of Plasmalyte® versus Ringer lactate (RL) in critically ill burn patients, with a special focus on the plasma clearance of buffer anions (i.e. gluconate, acetate and lactate). We conducted a randomized trial between August 2017 and October 2018 in a tertiary teaching hospital in Paris, France. Patients with burn total body surface area >30% were randomized to receive Plasmalyte® or RL. The primary endpoint was the base excess (BE) 24 hours after inclusion. The secondary endpoints were acetate, gluconate and lactate plasma concentration, the strong ion difference (SID). Twenty-eight patients were randomized. Twenty-four hours after inclusion, plasma BE was not significantly different in the Plasmalyte® and RL groups (-0.9 [CI95% -1.8-0.9] vs -2.1 [CI95% -4.6-0.6] mmol/L respectively, p=0.26). Plasma gluconate concentration was higher in the Plasmalyte® group (p<0.001) with a maximum level of 1.86 (CI95% 0.98-4.0) mmol/L vs 0 (IC95% 0-0.15) mmol/L. Plasma acetate and lactate were not significantly different. Ionized calcium level was lower in the Plasmalyte® group (p=0.002). Hemodynamics did not differ between groups. To conclude, alkalinizing effect of Plasmalyte® was less important than expected with no difference in base excess compared to RL, in part due to gluconate accumulation. Acetate and lactate did not significantly accumulate. Plasmalyte® led to significantly lower ionized calcium levels.

Document type :

Journal articles

Domain :

Statistics [stat] / Applications [stat.AP]

Life Sciences [q-bio] / Human health and pathology / Tissues and Organs [q-bio.TO]

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https://hal-paris1.archives-ouvertes.fr/hal-02498198
Contributor : Solohaja Faniaha Dimby <>
Submitted on : Wednesday, March 4, 2020 - 11:28:46 AM
Last modification on : Wednesday, October 14, 2020 - 4:01:42 AM

Physiological response to fluid resuscitation with Ringer Lactate versus Plasmalyte in critically ill burn patients.

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Physiological response to fluid resuscitation with Ringer Lactate versus Plasmalyte in critically ill burn patients.

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