Traumatic hemorrhagic shock (THS) is a major cause of early trauma-related mortality, with endothelial glycocalyx degradation playing a central role in microvascular dysfunction and systemic inflammation. Sodium bicarbonate Ringer’s solution (BR) has been proposed as an improvement over traditional sodium lactate Ringer’s solution (LR) by correcting acidosis and is hypothesized to improve early biochemical markers consistent with endothelial glycocalyx preservation, but clinical evidence remains limited. A prospective randomized controlled trial was conducted between October 2020 and March 2024. A total of 103 patients were assessed for eligibility. Five patients were excluded before randomization, including three who did not meet the inclusion criteria and two for whom consent was not obtained. Ninety-eight patients were subsequently randomized in a 1:1 ratio to BR (n=49) and LR (n=49). Serum glycocalyx injury markers (syndecan-1, heparanase, glypican-1, CD44), inflammatory cytokines (TNF-α, IL-4), and acid–base parameters were measured at baseline and 1 hour after resuscitation. A rat hemorrhagic shock model was used for mechanistic validation. A total of 103 patients were assessed for eligibility. Five were excluded before randomization, including patients who did not meet the eligibility criteria or in whom consent could not be obtained. Ninety-eight patients were subsequently randomized, and no participant in the randomized cohort received blood product transfusion during the prespecified first-hour observation window. Compared with LR, BR was associated with lower of serum syndecan-1, heparana se, glypican-1, CD44, and TNF-α levels after adjustment for baseline values (all p<0.01). BR also more effectively improved arterial pH, bicarbonate concentration, base excess, and lactate clearance. Rat model findings corroborated the clinical results. T hese changes were consistent with reduced glycocalyx injury and a less pronounced inflammatory response. Compared with LR, BR was associated with improved early biochemical markers consistent with endothelial glycocalyx integrity, a less pronounced inflammatory response, and improved acid-base status in both clinical and experimental THS settings. These findings suggest that BR may be a useful early resuscitation fluid, but long-term clinical outcomes were not assessed in this trial.
Zhang et al. (Wed,) studied this question.