Comparison of the acute hemodynamic effects of hypertonic or colloid infusions immediately after mitral valve repair

Sirieix, D.; Hongnat, Jean-Marc; Delayance, S.; D’Attellis, Nicola; Vicaut, Éric; Berrébi, Alain; Pâris, M.; Fabiani, Jean‐Noël; Carpentier, A; Baron, J. F.

doi:10.1097/00003246-199910000-00014

Cited by 54 publications

(42 citation statements)

References 18 publications

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“…The cardiac effects of hypertonic saline we observed are similar to those from experiments performed in conscious individuals that demonstrated positive inotropic effects of hypertonic resuscitation (8,27,28). In contrast, studies investigating the direct cardiac effects of hypertonicity in vitro (25) and in isolated heart preparations (34), as well as in anesthetized animals and humans (5,10,13,22,38), found no or negative effects on cardiac contractility and/or output.…”

Section: Discussionsupporting

confidence: 81%

Hypertonic sodium resuscitation after hemorrhage improves hemodynamic function by stimulating cardiac, but not renal, sympathetic nerve activity

Frithiof

Ramchandra

Hood

et al. 2011

American Journal of Physiology-Heart and Circulatory Physiology

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Frithiof R, Ramchandra R, Hood SG, May CN. Hypertonic sodium resuscitation after hemorrhage improves hemodynamic function by stimulating cardiac, but not renal, sympathetic nerve activity. Am J Physiol Heart Circ Physiol 300: H685-H692, 2011. First published December 10, 2010 doi:10.1152/ajpheart.00930.2010.-Small volume hypertonic saline resuscitation can be beneficial for treating hemorrhagic shock, but the mechanism remains poorly defined. We investigated the effects of hemorrhagic resuscitation with hypertonic saline on cardiac (CSNA) and renal sympathetic nerve activity (RSNA) and the resulting cardiovascular consequences. Studies were performed on conscious sheep instrumented with cardiac (n ϭ 7) and renal (n ϭ 6) sympathetic nerve recording electrodes and a pulmonary artery flow probe. Hemorrhage (20 ml/kg over 20 min) caused hypotension and tachycardia followed by bradycardia, reduced cardiac output, and abolition of CSNA and RSNA. Resuscitation with intravenous hypertonic saline (1.2 mol/l at 2 ml/kg) caused rapid, dramatic increases in mean arterial pressure, heart rate, and CSNA, but had no effect on RSNA. In contrast, isotonic saline resuscitation (12 ml/kg) had a much delayed and smaller effect on CSNA, less effect on mean arterial pressure, no effect on heart rate, but stimulated RSNA, although the plasma volume expansion was similar. Intracarotid infusion of hypertonic saline (1 ml/min bilaterally, n ϭ 5) caused similar changes to intravenous administration, indicating a cerebral component to the effects of hypertonic saline. In further experiments, contractility (maximum change in pressure over time), heart rate, and cardiac output increased significantly more with intravenous hypertonic saline (2 ml/kg) than with Gelofusine (6 ml/kg) after hemorrhage; the effects of hypertonic saline were attenuated by the ␤-receptor antagonist propranolol (n ϭ 6). These results demonstrate a novel neural mechanism for the effects of hypertonic saline resuscitation, comprising cerebral stimulation of CSNA by sodium chloride to improve cardiac output by increasing cardiac contractility and rate and inhibition of RSNA. brain; sodium chloride; sheep; conscious; saline; shock SEVERE HEMORRHAGE IS A LEADING cause of death and morbidity (30). Hypertonic saline solutions are frequently used for resuscitation in states of shock, having beneficial cardiovascular effects comprising improved cardiac output (CO), blood pressure, and regional blood flows (32) and leading to prompt restoration of oxygen delivery. Plasma volume expansion, caused by cellular dehydration via an osmotic gradient, partly accounts for these effects. There is, however, evidence that hypertonic saline has important additional actions to increase cardiac function, as similar increases in plasma volume by other fluids cause less improvement in CO (2). Studies investigating the direct effects of elevated osmolality/sodium levels on the heart have rendered inconclusive results, showing increased, decreased, or no effect on cardiac performance (5,10,13,2...

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Section: Discussionsupporting

confidence: 81%

Hypertonic sodium resuscitation after hemorrhage improves hemodynamic function by stimulating cardiac, but not renal, sympathetic nerve activity

Frithiof

Ramchandra

Hood

et al. 2011

American Journal of Physiology-Heart and Circulatory Physiology

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“…With the combination of a macromolecule and hypertonic NaCl, molecules remain a longer time in the intravascular space, increasing colloid osmotic pressure and plasma volume. Fluid is absorved from the interstitial intracellular space allowing for a more lasting restoration of blood volume 6,14 . This study showed short-term results of volume replacement using two different solutions in hypovolemia.…”

Section: Discussionmentioning

confidence: 99%

“…However, the cost of these solutions is high and there is a potential risk of allergic reactions and blood dyscrasia 2 . The use of small-volume hypertonic solutions for ressuscitation has proved to be an interesting alternative in experimental models of hemorrhagic shock 6 . Pioneer studies conducted in Brazil in the eighties have revealed that the infusion of small volumes of 7.5% NaCl solution produces rapid restoration of hemodynamic parameters and thus less demand for blood transfusions 7 .…”

Section: Introductionmentioning

confidence: 99%

Hemodynamic effects of volume replacement with saline solution and hypertonic hydroxyethyl starch in dogs

et al. 2009

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Purpose: To investigate hemodynamic response to volume replacement with saline solution and hypertonic hydroxyethyl starch in hypovolemic dogs. Methods: Forty dogs under general anesthesia and hemodynamic monitoring, following measurements at baseline, were bled 20 ml.Kg -1 and parameters were measured again after 10 minutes. The animals were randomly divided in two groups and volume replacement was performed with saline solution twice the volume removed or 4 ml.Kg -1 of hypertonic hydroxyethyl starch. Hemodynamic data were again measured after 5, 15, 30, 45 and 60 minutes. Results: With both solutions values returned to satisfactory hemodynamic levels. With saline solution, there was a greater amplitude in variations that tended to decrease progressively. With hypertonic hydroxyethyl starch, the parameters studied returned more rapidly to levels similar to those at baseline and varied less. Conclusion: Both solutions proved to be efficient at replacing volume in the short period studied, although hypertonic hydroxyethyl starch produced more stable results. Key words: Hemodynamics. Hypovolemia. Hetastarch. Saline Solution, Hypertonic. Dogs. RESUMOObjetivo: Avaliar em cães hipovolêmicos as respostas hemodinâmicas da reposição volêmica com solução salina e hidroxi-etil amido hipertônico. Métodos: Quarenta cães sob anestesia geral e monitorização hemodinâmica, após medidas em repouso foram sangrados 20 ml.Kg -1 e tiveram os parâmetros novamente medidos após 10 minutos. Os animais foram aleatoriamente divididos em dois grupos nos quais foi realizada reposição volêmica com solução fisiológica duas vezes o volume retirado ou 4 ml.Kg -1 de hidroxi-etil amido hipertônico e os dados hemodinâmicos medidos novamente após 5, 15, 30, 45 e 60 minutos. Resultados: A reposição volêmica com as duas soluções fez os valores retornarem a níveis hemodinâmicos satisfatórios, a amplitude das variações com solução fisiológica foi maior, mas tendeu a diminuir progressivamente, com o hidroxi-etil amido hipertônico os parâmetros estudados retornaram a semelhantes ao repouso mais rapidamente e variaram menos. Conclusão: Ambas soluções se mostraram eficientes na reposição volêmica, o hidroxi-etil amido hipertônico proporcionou resultados mais estáveis.

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“…Инфузия 250 мл ГР (в течение 15 мин) c целью коррек ции гиповолемии у пациентов после операций протезирования митрального клапана приводила к увеличению преднагрузки и фракции выброса ЛЖ [28]. В связи с этим использование ГР может представлять интерес у пациентов с низкими сократи тельными резервами миокарда, что, однако, требует коррекции дозировки и скорости введения препарата.…”

Section: о б з о р ыunclassified

“…Однако авторы наблюдали значимый прирост САД после инфузии ГР у боль шинства своих пациентов по сравнению с контрольной груп пой. У данных пациентов также отмечался более высокий прирост в ЦВД после инфузии ГР [28]. Феномен гипотонии основывается на периферической вазодилатации, которая объясняется рядом исследователей повышением плазменной осмолярности как с измененной, так и неизмененной концен трацией плазменного Na + [20,26,30].…”

Section: о б з о р ыunclassified

Use of Hypertonic Sodium Chloride Solution at Surgery under Extracorporeal Circulation

Ломиворотов¹,

Фоминский²,

Непомнящих³

2012

rmt

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Comparison of the acute hemodynamic effects of hypertonic or colloid infusions immediately after mitral valve repair

Cited by 54 publications

References 18 publications

Hypertonic sodium resuscitation after hemorrhage improves hemodynamic function by stimulating cardiac, but not renal, sympathetic nerve activity

Hypertonic sodium resuscitation after hemorrhage improves hemodynamic function by stimulating cardiac, but not renal, sympathetic nerve activity

Hemodynamic effects of volume replacement with saline solution and hypertonic hydroxyethyl starch in dogs

Use of Hypertonic Sodium Chloride Solution at Surgery under Extracorporeal Circulation

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