Comparison of lactated Ringer's, gelatine and blood resuscitation on intestinal oxygen supply and mucosal tissue oxygen tension in haemorrhagic shock

Knotzer, Hans; Pajk, Werner; Maier, Stephan; Dünser, Martin W.; Ulmer, Hanno; Schwarz, Birgit; Salak, Natalie; Hasibeder, Walter

doi:10.1093/bja/ael208

Cited by 33 publications

(20 citation statements)

References 25 publications

(15 reference statements)

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“…Under the bunker of stable vital signs lies the problems of GI hypoxia and ischemia, or occult GI shock [12,13] . Since the mid and late 1990s, comprehensive resuscitation strategies for maintaining the stability of vital signs and splanchnic resuscitation to restore GI blood supply as early as possible and reduce hypoxic and ischemic injuries as mush as possible have been recommended [14] . It is suggested that small doses of dopamine should be administered to dilate the renal and GI vessels [15] , and free oxygen radical clearing agents to attenuate ischemia/ reperfusion injury in the process of resuscitation [16,17] .…”

Section: Discussionmentioning

confidence: 99%

Prevention and treatment of gastrointestinal dysfunction following severe burns: A summary of recent 30-year clinical experience

Xiao¹,

Zhu²,

Xia³

et al. 2008

WJG

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(P < 0.05 or P < 0.01), and the occurrence of stress ulcer was also significantly lower than that in stage 2 patients (P < 0.05). CONCLUSION: Comprehensive fluid resuscitation, early excision of necrotic tissue, staged food ingestion, and administration of specific nutrients are essential strategies for preventing gastrointestinal complications and lowering mortality in severely burned patients. INTRODUCTIONGastrointestinal dysfunction is a common complication of severe burns. Injury to GI function, especially to GI barrier function, is an important initiator as well as a stimulator for occurrence of systemic inflammatory response syndrome (SIRS), sepsis and multiple organ dysfunction syndrome (MODS) following severe burns [1] . With the deeper understanding of GI function and changes in the stereotype of clinical treatment in recent 30 years, a series of new therapies including fluid resuscitation, early escharectomy, continuous renal replacement therapy, and use of glutamine and growth factor has been adopted in the treatment of severe burns [2,3] . Although animal experiments have shown that these new therapies do play a positive role in the prevention and treatment of GI dysfunction following severe burns, there has been a lack of convincing clinical Abstract AIM: To sum up the recent 30-year experience in the prevention and treatment of gastrointestinal dysfunction in severe burn patients, and propose practicable guidelines for the prevention and treatment of gastrointestinal (GI) dysfunction. METHODS: From 1980 to 2007, a total of 219 patients with large area and extraordinarily large area burns (LAB) were admitted, who were classified into three stages according the therapeutic protocols used at the time: Stage 1 from 1980 to 1989, stage 2 from 1990 to 1995, and stage 3 from 1996 to 2007. The occurrence and mortality of GI dysfunction in patients of the three stages were calculated and the main causes were analyzed. RESULTS: The occurrence of stress ulcer in patients with LAB was 8.6% in stage 1, which was significantly lower than that in stage 1 (P < 0.05). No massive hemorrhage from severe stress ulcer and enterogenic infections occurred in stages 2 and 3. The occurrence of abdominal distension and stress ulcer and the mortality in stage 3 patients with extraordinarily LAB was 7.1%, 21.4% and 28.5%, respectively, which were significantly lower than those in stage 1 patients

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Section: Discussionmentioning

confidence: 99%

Prevention and treatment of gastrointestinal dysfunction following severe burns: A summary of recent 30-year clinical experience

Xiao¹,

Zhu²,

Xia³

et al. 2008

WJG

View full text Add to dashboard Cite

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“…Besides this, the intestinal tract is one of the organs that precociously suffers the consequences of the mechanism of post-shock hemorrhagic ischemia 8 , causing the release of inflammatory cytokines, toxins and bacterial translocation with serious systemic repercussions and, it is believed, that these alterations can negatively influence intestinal anastomoses. 3 Considering ethical and practical aspects in the evaluation of this variable, the influence of the state of hemorrhagic shock in patients with intestinal anastomoses, a study model in animals has been elaborated. The model of hypovolemic shock developed was obtained by the removal of half millimeter of blood until the 50 mmHg mean arterial pressure value is reached or when the corresponding volume of 30% of the total volume of the rat is reached.…”

Section: Discussionmentioning

confidence: 99%

“…The excess of lactate, as an indicator of the lack of oxygen, has been studied to evaluate the seriousness of the state of shock in humans and in experimental models 2,3 . It is considered a quite reliable parameter for shock intensity when comparing the measurements of arterial pressure and heart insufficiency 10,11 .…”

Section: Discussionmentioning

confidence: 99%

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Hemorrhagic shock influence on colonic anastomoses in rats: evaluation of rupture by liquid distension resistance test

et al. 2008

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PURPOSE: To evaluate the effect of hemorrhagic shock in colonic anastomoses in rats, with a rupture by liquid distension resistance test. METHODS: Wistar lineage rats, averaging 90 days old and weighing from 310 to 380 grams were divided into two groups. In the first group (G1), 10 animals were submitted to colonic anastomoses in normovolemic terms and the second group (G2), of 10 animals, was submitted to colonic anastomoses in hypovolemic conditions. The shock was caused by half milliliter of blood withdrawn, every two minutes, until the value of average 50mmHg arterial pressure or a total volume corresponding 30% withdrawal of volemia was reached. Serum lactate dosages were carried out at the beginning and end of the procedure. The average serum lactate values at the end of the surgery were 1.91 mmol/l in G1 group and 3.69 mmol/l in G2 group (p<0.05). On the fifth postoperative day, the animals were euthanized. The anastomoses were evaluated with a rupture by liquid distension resistance test. RESULTS: In G1, the average value of colonic rupture was 160.7 mmHg whereas in G2 it was 152.1mmHg (p>0.05). CONCLUSION: Hemorrhagic shock, under the established conditions of this study, had no influence on colonic anastomoses in rats evaluated with the rupture by liquid distention resistance test.

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“…Several artificial molecules have been developed as plasma substitutes, and the efficiency of theses molecules on volume resuscitation have been evaluated (1)(2)(3)(4)(5); however, the effects of the solvent for the molecules on volume resuscitation have not been elucidated. Two kinds of molecule, dextran-40 and hydroxyethyl starch 70/0.5/4, are clinically available in Japan; dextran-40 is dissolved in either lactated-Ringer's solution or 5% glucose, and hydroxyethyl starch 70/0.5/4 is dissolved…”

Section: Introductionmentioning

confidence: 99%

Glucose administration during volume resuscitation using dextran-40 from hemorrhagic shock ameliorates acid/base-imbalance in fasted rats under sevoflurane anesthesia

2013

Biosci Trends

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Comparison of lactated Ringer's, gelatine and blood resuscitation on intestinal oxygen supply and mucosal tissue oxygen tension in haemorrhagic shock

Abstract: Blood or gelatine infusion improves mucosal tissue oxygenation of the porcine jejunum after severe haemorrhage when compared with lactated Ringer's solution.

Cited by 33 publications

References 25 publications

Prevention and treatment of gastrointestinal dysfunction following severe burns: A summary of recent 30-year clinical experience

Prevention and treatment of gastrointestinal dysfunction following severe burns: A summary of recent 30-year clinical experience

Hemorrhagic shock influence on colonic anastomoses in rats: evaluation of rupture by liquid distension resistance test

Glucose administration during volume resuscitation using dextran-40 from hemorrhagic shock ameliorates acid/base-imbalance in fasted rats under sevoflurane anesthesia

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