Low Volume Resuscitation with Cell Impermeants
Annual rept. 30 Sep 2013-29 Sep 2014
VIRGINIA COMMONWEALTH UNIV RICHMOND
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Circulatory shock induces the loss of energy dependent volume control mechanisms, which cause lethal cell swelling, compression of capillaries by swollen tissues, and impairment of the microcirculation. The objective of the study was to increase the tolerance to the low flow state by passively moving water from the cell back into the microcirculation by loading patients with cell impermeant and oncotic agents, which osmotically pull water from the cell and interstitial space, respectively. Rats were hemorrhaged to a plasma lactate of 10 mM, given a low volume resuscitation LVR with saline control or various cell impermeants and colloids. When lactate again reached 10 mM following LVR, full resuscitation was started with crystalloid and red cells. Capillary blood flow was measured by the colored microsphere technique. Impermeants dramatically improved LVR outcomes in shocked rats. Small cell impermeants and PEG-20k in LVR solutions increased tolerance to the low flow state by 2 and 5 fold, respectively, normalized arterial pressure during LVR, and increased survival 100 Vs 0 This was accompanied by higher capillary blood flow. Conclusions Ischemia-induced lethal cell swelling during hemorrhagic shock is a key mediator of resuscitation injury, which can be prevented by cell impermeants in LVR solutions.
- Medicine and Medical Research