The objective of this trial to see whether: -Cardiac performance (cardiac index and secondary outcomes)can be improved in patients with acute heart failure (AHF) and symptoms and consequences of fluid overload (pulmonary and interstitial edema) and poor peripheral perfusion can be reduced by: 1. Providing lactate as a substrate(Improve cardiac index) 2. Simultaneously restoring optimal preload Optimal standard treatment will be achieved in both arms with the use of current best treatment protocol for AHF as per independent treating physician. 4\. To assess effects of 0.5M Na lactate (Totilac) on plasma and urine biological parameters (sodium, potassium, chloride, pH, bicarb, base excess, albumin) 5\. To assess effects of 0.5M Na lactate on morbidity and mortality.
* Acute heart failure is a critical illness for which current treatments are suboptimal. * The various symptoms are related to inadequate cardiac output and usually include left ventricular overload with pulmonary oedema, interstitial fluid accumulation and tissue oedema (as indicated by frequent hyponatremia and hypoalbuminemia) and insufficient peripheral perfusion frequently manifesting as cold extremities and low urine output. * The current treatment of this syndrome is based on diuretics, vasodilators and/or inotropes, but fluid administration is also required to optimise the intravascular volume state and to reverse shock if present. Therefore management of body fluid balance remains a challenge since treatment aims to simultaneously maintain or improve intravascular volume and decrease body fluid excess and oedema. * The purpose of the present study is to assess in a prospective randomised trial the efficacy and safety of a newly designed crystalloid solution, 0.5 M sodium lactate, with properties potentially able to improve multiple pathophysiological aspects of AHF, as compared to the use of standard crystalloid solution Compound Sodium Lactate (mildly hypoosmolar \~ 274 mOsm/L and isotonic).
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
TRIPLE
Enrollment
41
A bolus of 0.5M Sodium lactate of 3 ml per kg BW is administered in 15 minutes, followed by a continuous infusion with 1 ml per kg per hour for 24 hours, i.e. in total 27 ml per kg over 24 hours
Hartmann's solution of 3 ml per kg BW is administered in 15 minutes, No infusion thereafter i.e. in total 3 ml per kg over 24 hours
Dept. of Intensive Care, Nepean Hosp., U Sydney
Penrith, New South Wales, Australia
Efficacy
Improvement in cardiac output measured by transthoracic echocardiography at 24 hours from initiation of study drug infusion
Time frame: Baseline till 24 hours from first loading of study drug
mortality
range of efficacy and safety parameters
Time frame: up to 3 month
acid base and electrolytes, fluid balance
the effect on on pH, base excess, bicarbonate, sodium, potassium, phosphate, chloride and lactate will be assessed during the study period
Time frame: 48 hours
organ function
effect on respiratory function assessed by time on ventilatory support and renal function measured by creatinine level over 48 hours will be assessed
Time frame: 48 hours
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