Optimal Fluid Use of Hypotensive Resuscitation and Transport
Technical Report,01 Jul 2014,31 Oct 2016
CINCINNATI UNIV OH CINCINNATI United States
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Hypertonic crystalloid solutions, colloids, and fresh whole blood have all been proposed for prehospital resuscitation after hemorrhage. However, there are no direct comparisons of the efficacy of these different fluids. We compared Hextend, 3 hypertonic saline HS, and fresh whole blood FWB in a porcine model of hemorrhagic shock. Female swine n5 per group underwent splenectomy and pressure-controlled hemorrhage followed by resuscitation with Hextend, 3 HS, or FWB. They were maintained at a target mean arterial pressure MAP for 4 hours, holding or infusing fluid as necessary. Sham animals for comparison underwent splenectomy alone. The mean volume required to maintain target MAP was significantly higher for 3 HS 1016386 mL than for Hextend 346299 mL, p0.01 or FWB 467189 mL, p0.04. After 4 hours of resuscitation, the MAP in the 3 HS group 443 mmHg was significantly lower than shams 567 mmHg, p0.01. Three percent HS recipients had significantly worse metabolic acidosis and anemia than all other groups as well as significantly higher serum sodium than all other groups and significantly higher serum chloride than shams or FWB recipients. Serum interleukin-6 was significantly elevated in 3 HS recipients relative to Hextend recipients 105.358.6 vs. 38.627.1 pcgmL, p0.04. Hypertonic saline performed inferiorly to Hextend as a volume-expanding resuscitative fluid after hemorrhage. Based on our data, we would not recommend the use of 3 saline as the sole resuscitation fluid after hemorrhage.
- Medicine and Medical Research
- Anatomy and Physiology