The acute effects of acetate-balanced colloid and crystalloid resuscitation on renal oxygenation in a rat model of hemorrhagic shock

Abstract

While resuscitation with the NaCl and RA (crystalloid solutions) and the HES-NaCl (unbalanced colloid solution) led to hyperchloremic acidosis, resuscitation with the HES-RA (acetate-balanced colloid solution) did not. The HES-RA was furthermore the only fluid restoring renal blood flow back to ∼85% of baseline level and most prominently improved renal microvascular oxygenation.

Effects of goal-directed fluid therapy with different lactated Ringer’s: hydroxyethyl starch ratios in hemorrhagic shock dogs

“…Because crystalloids (e.g., LR) are poor plasma expanders, 80% of the given volume would have shifted into the extracellular space (Almaca et al, 2012). The shift from the intravascular space can be aggravated by endothelial injury, capillary leakage, and accumulating extracellular edema, all of which are common pathophysiological mechanisms during hemorrhagic shock (Ertmer et al, 2011) In our 3:1 group, we observed pulmonary interstitial fluid accumulation, which led to an increase in the EVLWI and lung wet weight:dry weight ratios, and consequently a decrease in PaO 2 compared with the 1:3 group and the baseline value.…”

“…In essence, 6% HES 130/0.4 is a kind of saline-based colloid solution, whereas LR is a balanced crystalloid solution. Although saline-based solutions have been associated with disturbed acid-base balance because of their non-physiological electrolyte composition and pH (Wilcox, 1983;Scheingraber et al, 1999), they remain to be popular choices for volume replacement therapy in perioperative care (Almaca et al, 2012). In addition, saline-based solutions are known to be more frequently associated with hyperchloremic acidosis, owing to their high levels of chloride, resulting in renal vascular constriction and potentially to renal dysfunction (Williams et al, 1999;Brill et al, 2002;Almaca et al, 2012).…”

“…This suggests that resuscitation with large amounts of HES leads to hyperchloremia, which produces a relative hyperchloremic acidosis. Furthermore, hyperchloremia may lead to renal function decrease by triggering renal vascular constriction and decreased renal perfusion (Almaca et al, 2012). Conversely, buffers (i.e., lactate) found in LR may be converted to bicarbonate in the liver and contribute to a lesser degree of acidemia, or increase the pH .…”

“…Clearcrea (mL/min) was assessed as an index of the glomerular filtration rate, according to the following standard formula: Clearcrea = (Ucrea x V) / Pcrea, where Ucrea is the concentration of creatinine in urine, V is the urinary volume per minute, and Pcrea is the concentration of creatinine in plasma (Almaca et al, 2012).…”

Application of pulsed arterial resuscitation in a rabbit model of hemorrhagic shock

“…The main causes of death secondary to hemorrhagic shock are tissue hypoperfusion, major bleeding, and reperfusion injury, which can lead to multiple organ dysfunction syndrome. [8][9][10][11][12] Hemorrhagic shock is characterized by tissue hypoperfusion caused by a sharp reduction in the effective circulating volume of blood. Therefore, the key to successful resuscitation lies in eliminating the shock as soon as possible while simultaneously restoring blood perfusion to the bilateral common carotid arteries, if the liquid is infused through one side of the common carotid artery, the infusion will not cause reduction in blood flow to the brain because of the compensation from the other side.…”