Small-volume infusion of 7.5% NaCl in 6% dextran 70® for the treatment of severe hemorrhagic shock in swine

Maningas, Peter A; DeGuzman, Leonides R; Tillman, Fred J; Hinson, Charles S; Priegnitz, Kathy J; Volk, Kenneth A.; Bellamy, Ronald F.

doi:10.1016/s0196-0644(86)80852-6

Cited by 100 publications

(32 citation statements)

References 13 publications

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“…In the controlled hemorrhage studies, investigators commonly administered equal volumes of hypertonic and isotonic saline. [2][3][4][5][6][7] The hypertonic saline-treated animals therefore received significantly greater sodium loads as compared with the isotonic saline-treated animals. The relevance of this becomes apparent when one considers the mechanisms by which HTS is thought to restore hemodynamics: 1) by inducing an osmotic fluid shift from the intracellular to the extracellular space, resulting in intravascular expansion, 2) by decreasing total peripheral resistance, and 3) by increasing myocardial contractility.…”

Section: Discussionmentioning

confidence: 99%

“…Previous animal studies have similarly used infusion volumes higher than the standard 4 mL/kg. 4,5,32,33 In fact, the accepted 4 mL/kg infusion volume is arbitrary; to date, we know of no definitive study that has specifically evaluated the efficacy and potential untoward effects of various infusion volumes of hypertonic saline either with or without dextran.…”

Section: Limitations and Future Questionsmentioning

confidence: 99%

“…The data consistently demonstrate improved outcome with infusion of 7.5% NaCl/6% dextran 70 as compared with either 7.5% NaCl or 6% dextran 70. 3,4,34,37 Maningas et al compared resuscitation with 11.5 mL/kg of HSD with that of an equal volume of HTS, 6% dextran 70 (DEX), and NS. 4 In this experiment swine were bled 45 mL/kg in a controlled fashion over 15 minutes, resuscitated, and then observed for 96 hours.…”

Section: Limitations and Future Questionsmentioning

confidence: 99%

“…3,4,34,37 Maningas et al compared resuscitation with 11.5 mL/kg of HSD with that of an equal volume of HTS, 6% dextran 70 (DEX), and NS. 4 In this experiment swine were bled 45 mL/kg in a controlled fashion over 15 minutes, resuscitated, and then observed for 96 hours. Ninety-six-hour survival rates were significantly greater in the HSD-as compared with the NS-and HTS-treated animals.…”

Section: Limitations and Future Questionsmentioning

confidence: 99%

“…Several animal studies of acute hemorrhagic hypotension have demonstrated that smallvolume infusions of HTS and HSD are more effec-tive in increasing BP, increasing cardiac output, and providing volume expansion as compared with conventional isotonic crystalloids. [2][3][4][5][6][7][8][9][10] Based on these studies, several authors have advocated the out-of-hospital administration of hypertonic crystalloids for acute hemorrhagic shock. However, not all of the hypertonic saline studies have demonstrated improvement in outcome from resuscitation of acute hemorrhage.…”

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confidence: 99%

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Resuscitation of Severe Uncontrolled Hemorrhage 7.5% Sodium Chloride/6% Dextran 70 vs 0.9% Sodium Chloride

Stern¹,

Jwayyed²,

Dronen³

et al. 2000

Academic Emergency Medicine

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Abstract.Objectives: Resuscitation studies of hypertonic saline using controlled and uncontrolled hemorrhage models yield conflicting results with regard to efficacy. These disparate results reflect the use of models and resuscitation regimens that are not comparable between studies. This study evaluated the effects of comparable and clinically relevant resuscitation regimens of 7.5% sodium chloride/6% dextran 70 (HSD) and 0.9% sodium chloride (NS) in a near-fatal uncontrolled hemorrhage model. Methods: Thirty-six swine (14.2 to 21.4 kg) with 4-mm aortic tears were bled to a pulse pressure of 5 mm Hg (40-45 mL/kg). The animals were resuscitated with either NS or HSD administered in volumes that provided equivalent sodium loads at similar rates. Group II (n = 12) was resuscitated with 80 mL/kg of NS at a rate of 4 mL/kg/min. Group III (n = 12) received 9.6 mL/ kg of HSD at a rate of 0.48 mL/kg/min. In both groups, crystalloid resuscitation was followed by shed blood infusion (30 mL/kg) at a rate of 2 mL/kg/min. Group I (controls; n = 12) were not resuscitated. Results: One-hour mortality was significantly greater in group I (92%) as compared with group II (33%) and group III (33%) (Fisher's exact test; p = 0.004). Intraperitoneal hemorrhage was significantly greater in group II (34 Ϯ 20 mL/kg) and group III (31 Ϯ 13 mL/ kg) as compared with group I (5 Ϯ 2 mL/kg) (ANOVA; p < 0.05). There was no significant difference in hemodynamic parameters between groups II and III. Conclusion: In this model of severe uncontrolled hemorrhage, resuscitation with HSD or NS, administered in volumes that provided equivalent sodium loads at similar rates, had similar effects on mortality, hemodynamic parameters, and hemorrhage from the injury site. Key words: uncontrolled hemorrhage; shock; resuscitation; hypertonic saline; hemorrhage models; pig. ACADEMIC EMERGENCY MEDICINE 2000; 7:847-856 S TANDARD management of acute life-threatening hemorrhagic hypotension includes attempts to restore blood pressure (BP) to normal or near-normal levels through rapid administration of large volumes of isotonic crystalloid. 1 An alternative resuscitation agent that has shown considerable promise is 7.5% sodium chloride (HTS), used alone or in combination with 6% dextran 70 (HSD). Several animal studies of acute hemorrhagic hypotension have demonstrated that smallvolume infusions of HTS and HSD are more effec- tive in increasing BP, increasing cardiac output, and providing volume expansion as compared with conventional isotonic crystalloids. 2-10 Based on these studies, several authors have advocated the out-of-hospital administration of hypertonic crystalloids for acute hemorrhagic shock. However, not all of the hypertonic saline studies have demonstrated improvement in outcome from resuscitation of acute hemorrhage. More recent studies demonstrate that hypertonic saline resuscitation increases hemorrhage volume and mortality, presumably the result of a rapid rise in BP. [11][12][13][14][15] The authors of the latter studies therefore caution ...

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Section: Discussionmentioning

confidence: 99%

Section: Limitations and Future Questionsmentioning

confidence: 99%

Section: Limitations and Future Questionsmentioning

confidence: 99%

Section: Limitations and Future Questionsmentioning

confidence: 99%

mentioning

confidence: 99%

See 3 more Smart Citations

Resuscitation of Severe Uncontrolled Hemorrhage 7.5% Sodium Chloride/6% Dextran 70 vs 0.9% Sodium Chloride

Stern¹,

Jwayyed²,

Dronen³

et al. 2000

Academic Emergency Medicine

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7.5% Sodium Chloride/Dextran for Resuscitation of Trauma Patients Undergoing Helicopter Transport

Vassar¹

1991

Arch Surg

266

115

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To evaluate the use of hypertonic saline/dextran solutions in the prehospital resuscitation of severely injured patients, we administered 250 mL of either 7.5% sodium chloride/dextran 70 (HSD) (n = 83) or lactated Ringer's solution (n = 83), followed by conventional isotonic fluids, to 166 trauma patients with systolic blood pressures less than or equal to 100 mm Hg, in a prospective, randomized, double-blinded clinical trial. Patients in the sodium chloride/dextran 70 group required less fluid before hospitalization and arrived in the emergency department with higher systolic blood pressures than patients in the lactated Ringer's solution group. The rate of survival to hospital discharge for the entire cohort was 64% for patients in the sodium chloride/dextran 70 group vs 59% for patients in the lactated Ringer's solution group. The rate of survival to hospital discharge for the patients with severe head injuries was 32% for the sodium chloride/dextran 70 group vs 16% for the lactated Ringer's solution group. Actuarial survival for patients with severe head injuries in the sodium chloride/dextran 70 group compared with patients with severe head injuries in the lactated Ringer's solution group did not quite reach statistical significance. There were no adverse side effects associated with sodium chloride/dextran 70 administration. Administration of small volumes of sodium chloride/dextran 70 before hospitalization increased the blood pressure of severely injured patients more effectively than did lactated Ringer's solution and showed tendencies toward improving survival in the patients with severe head injuries.

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A Multicenter Trial for Resuscitation of Injured Patients With 7.5% Sodium Chloride

et al. 1993

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Prehospital infusion of 250 mL of 7.5% sodium chloride is associated with an increase in blood pressure and an increase in survival to hospital discharge compared with survival predicted by the MTOS norms. Patients with low baseline Glasgow Coma Scale scores seem to benefit the most from 7.5% sodium chloride resuscitation. Hypertonic saline solution without added dextran 70 is as effective as the more expensive solutions that contain dextran 70.

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Small-volume infusion of 7.5% NaCl in 6% dextran 70® for the treatment of severe hemorrhagic shock in swine

Cited by 100 publications

References 13 publications

Resuscitation of Severe Uncontrolled Hemorrhage 7.5% Sodium Chloride/6% Dextran 70 vs 0.9% Sodium Chloride

Resuscitation of Severe Uncontrolled Hemorrhage 7.5% Sodium Chloride/6% Dextran 70 vs 0.9% Sodium Chloride

7.5% Sodium Chloride/Dextran for Resuscitation of Trauma Patients Undergoing Helicopter Transport

A Multicenter Trial for Resuscitation of Injured Patients With 7.5% Sodium Chloride

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