Clinical Trial: Efficacy, Safety of Solution Containing Hyperosmolar Sodium Lactate Infusion for Resuscitation of Patients With Hemorrhagic Shock

Study Status: Completed
Recruit Status: Completed
Study Type: Interventional

Official Title: The Clinical Efficacy and Safety of a Proprietary Solution Containing Hypertonic Sodium Lactate (Totilac®) Infusion for Resuscitation of Patients With Hemorrhagic Shock

Brief Summary:

Indication: Resuscitation in pts with hemorrhagic shock due to multiple injuries

Prospective, open label RCT in pts. with traumatic hemorrhagic shock in RS Hasan Sadikin Hospital, Indonesia.

PI: Dr. Kiki Lukman, PsBD(K), Surgery, RSHS. Co-PI: (late)Prof. Xavier Leverve MD, PhD, Directeur, INSERM-E0221-Bioenergetique Fondamentale et Appliquée Université Joseph Fourier, France

Hemorrhagic shock is a cause of death in trauma.Fluid resuscitation to ensure stable hemodynamics and microcirculation by rapidly restoring circulating plasma volume could be a cornerstone of managing trauma patients. Excessive fluid accumulation particularly in the interstitial tissue should be avoided. Hypertonic solution shows promise in restoring intravascular volume expansion and microcirculation with less fluid infusion in hypovolemic patients. This study investigated efficacy and safety of hyperosmolar Na lactate(Totilac®) for resuscitating traumatic hemorrhagic shock patients.

Patients with multiple injuries with grade III hemorrhagic shock and RTS ≥4 received std initial fluid resuscitation of upto 2 liters of isotonic crystalloid. They also got similar dose of either hyperosmolar Na lactate or ringer's lactate. Hemodynamic status, fluid balance and and safety was recorded during the study.


Detailed Summary:

Trauma is still an important cause of death and disability worldwide.Trauma patients often experience fluid deficits. In addition to apparent blood loss, fluid deficit might also occur secondary to generalized alterations of the endothelial barrier, resulting in diffuse capillary leakage and fluid shift from the intravascular to the interstitial compartment. Severe volume deficits after trauma result in hemorrhagic shock that further leads to the decrease of tissue perfusion, especially to vital organs and inadequate delivery of oxygen and nutrients necessary for normal tissue and cellular function. Subsequently, inadequate and inappropriate management of hemorrhagic shock frequently results in the development of post trauma multiple organ failure which increases the morbidity and mortality of the patients. Consequences of hypovolemic shock (hemorrhagic shock) due to bleeding are one of the major causes of death in trauma patients. Therefore, fluid replacement to reverse shock and to restore perfusion to vital organs appears to be fundamental in the management of the trauma patient, after ensuring an adequate airway, oxygenation and ventilation.

Effective control of hemorrhage and adequate intravenous fluid administration to restore intravascular volume and maintain the tissue perfusion is crucial for saving the patient's life and resuscitation can exacerbate cellular injury caused by hemorrhagic shock, if resuscitation is not performed properly. The type of fluid used for resuscitation plays an important role in this injury pattern. However, when, how and which fluids are ideal in regards to fluid resuscitation remains controversial. The concept that early, aggressive large - volume resuscitation by administration of isotonic crystalloids in volumes 2 to 3 times the estimated blood loss has been widely accepted and practiced; it has even became the standard-of-care adopt
Sponsor: Innogene Kalbiotech Pte. Ltd

Current Primary Outcome: Urinary output (UOP) [ Time Frame: 3 hours ]

Original Primary Outcome: Same as current

Current Secondary Outcome:

  • Blood pressure [ Time Frame: 3 hours ]
  • Mean arterial pressure [ Time Frame: 3 hours ]
  • Heart rate [ Time Frame: 3 hours ]
  • Respiration rate [ Time Frame: 3 hours ]
  • Glasgow coma scale value [ Time Frame: 3 hours ]
  • Fluid balance [ Time Frame: 3 hours ]


Original Secondary Outcome: Same as current

Information By: Innogene Kalbiotech Pte. Ltd

Dates:
Date Received: August 10, 2011
Date Started: July 2009
Date Completion:
Last Updated: September 12, 2011
Last Verified: August 2011