Effect of Initial Fluid Resuscitation on Subsequent Treatment in Uncontrolled Hemorrhagic Shock in Rats

Nan, Xuemei; Wang, Xichun; Diao, Yun-Peng; Liu, Ren; Tian, Kui

doi:10.1097/01.shk.0000110622.42625.cb

Cited by 54 publications

(17 citation statements)

References 29 publications

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“…Relevant organ functions of the heart and kidneys showed a significant improvement according to the PiCCO measurement-treated group [27]. We attribute these results to better maintenance of systemic blood pressures leading to fewer requirements of catecholamines and improved perfusion of the kidneys which lowers systemic creatinin.…”

Section: Discussionmentioning

confidence: 99%

Optimized fluid management improves outcomes of pediatric burn patients

Kraft

Herndon

Branski

et al. 2013

Journal of Surgical Research

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Background One of the major determinants for survival of severely burned patients is appropriate fluid resuscitation. At present, fluid resuscitation is calculated based on bodyweight or body surface area, burn size, and urinary output. However, recent evidence suggests that fluid calculation is inadequate and that over- and under-resuscitation is associated with increased morbidity and mortality. We hypothesize that optimizing fluid administration during the critical initial phase using a transcardiopulmonary thermo-dilution monitoring device (PiCCO) would have beneficial effects on the outcome of burned patients. Methods A cohort of seventy-six severely burned pediatric patients with burns over 30% total body surface area (TBSA) who received adjusted fluid resuscitation using the PiCCO (P) system were compared to 76 conventionally monitored patients (C). Clinical hemodynamic measurements, organ function (DENVER2 score), and biomarkers were recorded prospectively for the first 20 days after burn injury. Results Both cohorts were similar in demographic and injury characteristics. Patients in the PiCCO group received significantly less fluids (p<0.05) with similar urinary output, resulting in a significantly lower positive fluid balance (p<0.05). The central venous pressure (CVP) in the P group was maintained in a more controlled range (p<0.05), associated with a significantly lower heart rate and significantly lower incidence of cardiac and renal failure, p<0.05. Conclusions Fluid resuscitation guided by transcardiopulmonary thermo-dilution during hospitalization represents an effective adjunct and is associated with beneficial effects on post-burn morbidity.

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Section: Discussionmentioning

confidence: 99%

Optimized fluid management improves outcomes of pediatric burn patients

Kraft

Herndon

Branski

et al. 2013

Journal of Surgical Research

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“…Although a sufficient fluid resuscitation is necessary for anti-shock, recent studies have suggested that the massive fluid resuscitation before effectively controlling the active bleeding may increase the blood loss or lead to dilutional coagulopathy. In the meantime, the increase of blood pressure can peel away the scar tissue and lead a rebleeding, which may increase the probability of complications 18. In addition, intra-abdominal bleeding and increased death rate were reported for uncontrolled hemorrhagic shock animals that were perfused with the hypertonic saline 17.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of the clinical effect of small-volume resuscitation on uncontrolled hemorrhagic shock in emergency

Zhao

Feng

et al. 2017

TCRM

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ObjectiveThe objective of the present study was to explore the resuscitative effect of small-volume resuscitation on uncontrolled hemorrhagic shock in emergency.MethodsIn this study, the resuscitative effects in 200 trauma patients with uncontrolled hemorrhagic shock in emergency were studied. Half of these patients were infused with hypertonic/hyperoncotic fluid (small-volume resuscitation group, n=100), whereas the rest were infused with Hespan and lactated Ringer’s solution (conventional fluid resuscitation group, n=100). The changes in hemodynamics, coagulation function, blood biochemistry, blood hematology, and the average infusion volume in both the groups were comparatively studied.ResultsIt was found that the hemodynamics were improved in both the groups after resuscitation. Interestingly, compared with trauma patients infused with Hespan and lactated Ringer’s solution, the growth rate, range, and time duration of the mean arterial pressure of the patients in small-volume resuscitation group increased significantly, and the shock index decreased progressively; in the 60th min after the resuscitation, blood index including hemoglobin, hematocrit, red blood cells, white blood cells, and platelet declined, whereas prothrombin time and activated partial thromboplastin time were prolonged in both the groups, but these changes were less obvious in the small-volume group. In addition, the average infusion volume of patients in the small-volume group was less than that of patients in conventional fluid resuscitation group.ConclusionFeatured with small infusion volume and less influence to coagulation function and homeostasis of human body, small-volume resuscitation possesses a significantly higher resuscitative effect. Therefore, trauma patients may have a better chance to maintain the hemodynamic stability and the survival rate, or recovery speed will be increased when traditional aggressive fluid resuscitation is replaced by small-volume resuscitation.

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“…Interestingly, if intravascular volume expansion successfully restores cardiac output and arterial blood pressure before definitive hemostasis has been achieved, then, paradoxically, resuscitation can promote bleeding and shorten survival (4)(5)(6)(7)(8). Additionally, conventional approaches toward resuscitation require administration of large volumes of fluids that are intrinsically heavy and bulky.…”

Section: Introductionmentioning

confidence: 95%

Survival in a Rat Model of Lethal Hemorrhagic Shock Is Prolonged Following Resuscitation With a Small Volume of a Solution Containing a Drag-Reducing Polymer Derived From Aloe Vera

Macias¹,

Kameneva

Tenhunen³

et al. 2004

Shock

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Drag-reducing polymers (DRP) increase tissue perfusion at constant driving pressure. We sought to evaluate the effects of small-volume resuscitation with a solution containing a DRP in a rat model of hemorrhage. Anesthetized rats were hemorrhaged at a constant rate over 25 min. In protocol A, total blood loss was 2.45 mL/100 g, whereas in protocol B, total blood loss was 3.15 mL/100 g. Five minutes after hemorrhage, the animals were resuscitated with 7 mL/kg of either normal saline (NS) or NS containing 50 microg/mL of an aloe vera-derived DRP. In protocol B, a third group (CON) was not resuscitated. Whole-body O2 consumption (Vo2) and CO2 production (Vco2) were measured using indirect calorimetry. In protocol A, 5/10 rats in the NS group and 8/10 rats in the DRP group survived for 4 h (P = 0.14). Mean arterial pressure was higher in the DRP-treated group than in the NS-treated group 45 min after resuscitation (89 +/- 8 vs. 68 +/- 5 mmHg, respectively; P < 0.05). In protocol B, survival rates over 2 h in the DRP, NS, and CON groups were 5/15, 1/14, and 0/7, respectively (P < 0.05). Compared with NS-treated rats, those resuscitated with DRP achieved a higher peak Vo2 (9.0 +/- 1.0 vs. 6,3+/- 1.0 mL/kg/min) and Vco2 (9.0 +/- 1.1 vs. 6.0 +/- 1.0 mL/kg/min) after resuscitation. We conclude that resuscitation with a small volume of DRP prolongs survival in rats with lethal hemorrhagic shock.

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Effect of Initial Fluid Resuscitation on Subsequent Treatment in Uncontrolled Hemorrhagic Shock in Rats

Cited by 54 publications

References 29 publications

Optimized fluid management improves outcomes of pediatric burn patients

Optimized fluid management improves outcomes of pediatric burn patients

Evaluation of the clinical effect of small-volume resuscitation on uncontrolled hemorrhagic shock in emergency

Survival in a Rat Model of Lethal Hemorrhagic Shock Is Prolonged Following Resuscitation With a Small Volume of a Solution Containing a Drag-Reducing Polymer Derived From Aloe Vera

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