Blood Loss after Fluid Resuscitation with Isotonic or Hypertonic Saline for the Initial Treatment of Uncontrolled Hemorrhage Induced by Spleen Rupture

Varicoda, E Y; Figueiredo, Luiz Francisco Poli de; Cruz, Ruy J.; Silva, Leonardo E.; Silva, Maurício Rocha e

doi:10.1097/01.ta.0000074350.61500.e0

Cited by 18 publications

(10 citation statements)

References 21 publications

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“…37–41 The timing and rate of HS infusion in these studies are important, as when fluid was administered at clinically relevant rates, significant rebleeding was not seen. 42 If increased bleeding was the primary mechanism for earlier mortality, one would anticipate higher mortality among penetrating rather than blunt trauma patients; however, the opposite effect was seen in this study.…”

Section: Discussionmentioning

confidence: 99%

Out-of-hospital Hypertonic Resuscitation After Traumatic Hypovolemic Shock

Bulger¹,

May²,

Kerby³

et al. 2011

Annals of Surgery

263

216

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Objective To determine whether out-of-hospital administration of hypertonic fluids would improve survival after severe injury with hemorrhagic shock. Background Hypertonic fluids have potential benefit in the resuscitation of severely injured patients because of rapid restoration of tissue perfusion, with a smaller volume, and modulation of the inflammatory response, to reduce subsequent organ injury. Methods Multicenter, randomized, blinded clinical trial, May 2006 to August 2008, 114 emergency medical services agencies in North America within the Resuscitation Outcomes Consortium. Inclusion criteria: injured patients, age ≥ 15 years with hypovolemic shock (systolic blood pressure ≤ 70 mm Hg or systolic blood pressure 71–90 mm Hg with heart rate ≥ 108 beats per minute). Initial resuscitation fluid, 250 mL of either 7.5% saline per 6% dextran 70 (hypertonic saline/dextran, HSD), 7.5% saline (hypertonic saline, HS), or 0.9% saline (normal saline, NS) administered by out-of-hospital providers. Primary outcome was 28-day survival. On the recommendation of the data and safety monitoring board, the study was stopped early (23% of proposed sample size) for futility and potential safety concern. Results A total of 853 treated patients were enrolled, among whom 62% were with blunt trauma, 38% with penetrating. There was no difference in 28-day survival—HSD: 74.5% (0.1; 95% confidence interval [CI], −7.5 to 7.8); HS: 73.0% (−1.4; 95% CI, −8.7–6.0); and NS: 74.4%, P = 0.91. There was a higher mortality for the postrandomization subgroup of patients who did not receive blood transfusions in the first 24 hours, who received hypertonic fluids compared to NS [28-day mortality—HSD: 10% (5.2; 95% CI, 0.4–10.1); HS: 12.2% (7.4; 95% CI, 2.5–12.2); and NS: 4.8%, P < 0.01]. Conclusion Among injured patients with hypovolemic shock, initial resuscitation fluid treatment with either HS or HSD compared with NS, did not result in superior 28-day survival. However, interpretation of these findings is limited by the early stopping of the trial.

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Section: Discussionmentioning

confidence: 99%

Out-of-hospital Hypertonic Resuscitation After Traumatic Hypovolemic Shock

Bulger¹,

May²,

Kerby³

et al. 2011

Annals of Surgery

263

216

View full text Add to dashboard Cite

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“…When administered, treatment was infused after 20 minutes of uncontrolled hemorrhage simulating a penetrating (Figure 4, iliac artery tear) 89 or a blunt abdominal injury ( Figure 5, splenic rupture) 90 . In both experimental models, untreated controls remained in severe hypotension and low blood flows.…”

Section: Safety and Controversiesmentioning

confidence: 99%

Small Volume Hypertonic Resuscitation of Circulatory Shock

Rocha-e-Silva

Figueiredo

2005

Clinics

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Small volume hypertonic resuscitation is a relatively new conceptual approach to shock therapy. It was originally based on the idea that a relatively large blood volume expansion could be obtained by administering a relatively small volume of fluid, taking advantage of osmosis. It was soon realized that the physiological vasodilator property of hypertonicity was a useful byproduct of small volume resuscitation in that it induced reperfusion of previously ischemic territories, even though such an effect encroached upon the malefic effects of the ischemia-reperfusion process. Subsequent research disclosed a number of previously unsuspected properties of hypertonic resuscitation, amongst them the correction of endothelial and red cell edema with significant consequences in terms of capillary blood flow. A whole set of actions of hypertonicity upon the immune system are being gradually uncovered, but the full implication of these observations with regard to the clinical scenario are still under study. Small volume resuscitation for shock is in current clinical use in some parts of the world, in spite of objections raised concerning its safety under conditions of uncontrolled bleeding. These objections stem mainly from experimental studies, but there are few signs that they may be of real clinical significance. This review attempts to cover the earlier and the more recent developments in this field.

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“…Several animal models have been used to simulate naturally occurring uncontrolled hemorrhage leading to shock by creating mesenteric injury,37 major vascular injury,38–39 solid organ injury,11,40 external hemorrhage,2,4 and retroperitoneal hematomas 28. Several studies quantified blood loss by weighing surgical sponges, some used the clearance technique with Evans’ blue or green indocyanine, and others employed the dilution technique with radiolabeled albumin or red blood cells radiolabeled with 99m Tc,41,42 or 51 Cr.…”

Section: Discussionmentioning

confidence: 99%

Blood Loss and Transcapillary Refill in Uncontrolled Treated Hemorrhage in Dogs

Sallum

Sinozaki

Calil

et al. 2010

Clinics

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OBJETIVE:This study evaluated retroperitoneal hematomas produced by bilateral injury of iliac arteries (uncontrolled hemorrhage), blood volume loss, transcapillary refill, the effects of volume replacement on retroperitoneal bleeding and the hemodynamic changes with and without treatment.METHODS:Initial blood volume was determined with Tc99m-labelled red cells, and bleeding was evaluated by means of a portable scintillation camera positioned over the abdomen. Previously splenectomized mongrel dogs (16.8 ± 2.2 kg) were submitted to hemorrhage for 30 minutes and randomized into three groups: I - no treatment (n=7); II - treatment with 32 mL/kg of Lactated Ringer’s for three to five minutes (n=7); and III - treatment with 4 mL/kg of 7.5% NaCl plus 6.0% dextran 70 for three to five minutes (n=7). They were studied for an additional 45 minutes.RESULTS:Volume replacement produced transitory recovery in hemodynamic variables, including mean pulmonary artery pressure, pulmonary capillary wedge pressure and cardiac index, with significant increase in dogs treated with 32 mL/kg of Lactated Ringer’s and 7.5% NaCl plus 6.0% dextran 70 (p<0.001, against no treatment), along with a decrease (p<0.001) in the systemic vascular resistance index. Groups II and III had significant initial decreases in hematocrit and hemoglobin. The treated dogs (groups II and III) presented rebleeding, which was greater during treatment with 32 mL/kg of Lactated Ringer’s (group II).CONCLUSIONS:Despite the rebleeding observed in treated groups, the utilization of hypertonic saline solution with dextran proved to be effective in the initial reanimation, producing evident transcapillary refill, while the Lactated Ringer’s solution produced capillary extravasation and was ineffective in the initial volume replacement in this model of uncontrolled hemorrhage.

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Blood Loss after Fluid Resuscitation with Isotonic or Hypertonic Saline for the Initial Treatment of Uncontrolled Hemorrhage Induced by Spleen Rupture

Abstract: No-fluid resuscitation in uncontrolled hemorrhage from splenic rupture resulted in a low-flow state, whereas resuscitation with small volumes of HSD or large volumes of LR produced hemodynamic benefits without significant increases in bleeding.

Cited by 18 publications

References 21 publications

Out-of-hospital Hypertonic Resuscitation After Traumatic Hypovolemic Shock

Out-of-hospital Hypertonic Resuscitation After Traumatic Hypovolemic Shock

Small Volume Hypertonic Resuscitation of Circulatory Shock

Blood Loss and Transcapillary Refill in Uncontrolled Treated Hemorrhage in Dogs

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