Mesenteric Microcirculatory Changes in Non-Lethal Hemorrhagic Shock: The Role of Balanced Eletrolyte and Hypertonic Saline/Dextran in Resuscitation

Efeitos hemodinâmicos e metabólicos imediatos determinados pelas soluções de cloreto de sódio a 7,5% e de sua associação ao dextran 70 a 6% na reanimação do choque hemorrágico: estudo experimental em cães

“…O efeito redutor de edema das células endoteliais foi particularmente importante nos capilares, onde o edema previamente instalado reduziu de modo significativo a luz do vaso, impondo restrição hemodinâmica significativa ao fluxo das hemácias. Este fato pode explicar a imediata retomada da função metabólica após a administração da solução hipertônica, em comparação com o mesmo efeito expansor de solução isotônica, na medida em que esta recompõe o volume circulante na mesma proporção, mas não remove de imediato o edema endotelial [54][55][56] . O gradiente osmótico das soluções com 2.400 mOsm.L -1 fez com que houvesse a remoção de fluidos intracelulares das hemácias e das células endoteliais, primeiramente, e, posteriormente, do interstício e da célula tecidual.…”

“…Reduction of the edema of the endothelial cells was particularly important in the capillaries, where previously settled edema reduced significantly vessel lumen, leading to an important reduction in red blood cell flow. This may explain the immediate recovery in metabolic function after the administration of hypertonic solution when compared with the same volume-expanding effect of the isotonic solution, since it recomposes the volume equally, but does not decrease endothelial edema immediately [54][55][56] . The osmotic gradient of solutions with 2400 mOsm.L -1 removed intracellular fluid, initially from the red blood cells and from endothelial cells, followed by the interstitial compartment and tissue cells.…”

Effects of Dextran and Pentoxifylline on Hemorrhagic Shock-Induced P-Selectin Expression

“…Intravital microscopic studies of the skeletal muscle and intestinal microcirculation have shown that the number of perfused capillaries is significantly reduced both during and after resuscitation of hemorrhagic shock [7][8][9]14]. Laser Doppler flowmetry has been used to demonstrate the persistence of reduced microvascular blood flow to several organs (lung, liver, kidney, stomach, intestines, brain) despite isotonic crystalloid fluid resuscitation [10, 12, 13, 15].…”

“…While no-reflow phenomenon and MODS persist despite crystalloid fluid resuscitation, resuscitation with solutions containing dextran have been shown to prevent leukocyte-endothelium adherence and, thus, no-reflow phenomenon and MODS [13,14,19,30]. Additionally, pentoxifylline infusion during resuscitation has also been shown to exert similar effects [31][32][33][34][35][36][37].…”

Hypertonic saline resuscitation improves intestinal microcirculation in a rat model of hemorrhagic shock

“…6,7 Similarly, in animal models of shock/resuscitation in which splanchnic vasculature and blood flow were directly determined, progressive vasoconstriction and hypoperfusion were observed even with adequate resuscitation that restored and maintained central hemodynamics. [8][9][10] In general, the goal of resuscitation should be the restoration of splanchnic and peripheral tissue perfusion not central hemodynamics.…”