Hextend and 7.5% Hypertonic Saline With Dextran Are Equivalent to Lactated Ringerʼs in a Swine Model of Initial Resuscitation of Uncontrolled Hemorrhagic Shock

• Published in: The Journal of trauma, injury, infection, and critical care Vol. 71; no. 6; pp. 1755 - 1760
• Main Authors: Riha, Gordon M., Kunio, Nicholas R., Van, Philbert Y., Hamilton, Gregory J., Anderson, Ross, Differding, Jerome A., Schreiber, Martin A.
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott Williams & Wilkins, Inc 01-12-2011; Lippincott Williams & Wilkins
• Subjects: Anesthesia; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Animals; Biological and medical sciences; Disease Models, Animal; Diseases of the osteoarticular system; Emergency and intensive cardiocirculatory care. Cardiogenic shock. Coronary intensive care; Female; Fluid Therapy - methods; General anesthesia. Technics. Complications. Neuromuscular blocking. Premedication. Surgical preparation. Sedation; Hemodynamics - physiology; Hydroxyethyl Starch Derivatives - pharmacology; Intensive care medicine; Isotonic Solutions - pharmacology; Medical sciences; Plasma Substitutes - pharmacology; Random Allocation; Resuscitation - methods; Risk Assessment; Saline Solution, Hypertonic - pharmacology; Shock, Hemorrhagic - mortality; Shock, Hemorrhagic - therapy; Single-Blind Method; Survival Rate; Sus scrofa; Swine; Treatment Outcome; Shock; Animal model; Hemorrhagic shock; Hemorrhage; Dextran; Vertebrata; Mammalia; Swine; Blood substitute; Anesthesia; Artiodactyla; Ungulata; Resuscitation
• ISSN: 0022-5282; 1529-8809
• DOI: 10.1097/TA.0b013e3182367b1c

BACKGROUND:The optimal fluid strategy for the early treatment of trauma patients remains highly debated. Our objective was to determine the efficacy of an initial bolus of resuscitative fluids used in military and civilian settings on the physiologic response to uncontrolled hemorrhagic shock in a prospective, randomized, blinded animal study.
METHODS:Fifty anesthetized swine underwent central venous and arterial catheterization followed by celiotomy. Grade V liver injury was performed, followed by 30 minutes of uncontrolled hemorrhage. Then, liver packing was completed, and fluid resuscitation was initiated over 12 minutes with 2 L normal saline (NS), 2 L Lactated Ringerʼs (LR), 250 mL 7.5% hypertonic saline with 3% Dextran (HTS), 500 mL Hextend (HEX), or no fluid (NF). Animals were monitored for 2 hours postinjury. Blood loss after initial hemorrhage, mean arterial pressure (MAP), tissue oxygen saturation (StO2), hematocrit, pH, base excess, and lactate were measured at baseline, 1 hour, and 2 hours.
RESULTS:NF group had less post-treatment blood loss compared with other groups. MAP and StO2 for HEX, HTS, and LR at 1 hour and 2 hours were similar and higher than NF. MAP and StO2 did not differ between NS and NF, but NS resulted in decreased pH and base excess.
CONCLUSIONS:Withholding resuscitative fluid results in the least amount of posttreatment blood loss. In clinically used volumes, HEX and HTS are equivalent to LR with regard to physiologic outcomes and superior to NF. NS did not provide a measurable improvement in outcome compared with NF and resulted in increased acidosis.