The Effects of Varying Fluid Volume and Rate of Resuscitation during Uncontrolled Hemorrhage

Soucy, Dana M.; Rude, Malcolm; Hsia, Wen C.; Hagedorn, Fred; Illner, H; Shires, G. Tom

doi:10.1097/00005373-199902000-00001

Cited by 44 publications

(24 citation statements)

References 21 publications

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“…Hence, the fast infusion of the "moderate" volume was associated with the lowest mortality (40%) while no resuscitation resulted in a mortality of 83%. 24 Surprisingly, the hemorrhage volume in the group with the poorest outcome was only 8 ml/kg, which would not cause death in pigs or humans.…”

Section: Anesthesia and Fluid Volumementioning

confidence: 94%

“…[22][23][24] Here, the choice of anesthesia appeared to have an impact on outcome. Ketamine, which retains vasoconstrictive responses, was associated with the highest mortality and the hypotensive anesthetic pentobarbital, which induces vasodilatation, with the lowest.…”

Section: Anesthesia and Fluid Volumementioning

confidence: 96%

“…[14][15][16] In contrast, vigorous fluid administration (80 ml/kg) promotes survival in the cut tail model, which represents a more peripheral vascular injury, although the hemorrhage volume might be larger. [22][23][24] Ambitious fluid therapy may not be as deleterious in uncontrolled hemorrhage from parenchymal organs. For example, in a model of liver injury in the rat, hypertonic saline maintained circulating blood volume and survival despite increased hemorrhage.…”

Section: Pathophysiologymentioning

confidence: 99%

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Fluid therapy in uncontrolled hemorrhage – what experimental models have taught us

Hahn

2012

Acta Anaesthesiol Scand

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Intravenous fluid is life-saving in hypovolemic shock, but fluid sometimes aggravates the bleeding. During the past 25 years, animal models have helped our understanding of the mechanisms involved in this unexpected effect. A key issue is that vasoconstriction is insufficient to arrest the bleeding when damage is made to a major blood vessel. ‘Uncontrolled hemorrhage’ is rather stopped by a blood clot formed at the outside surface of the vessel, and the immature clot is sensitive to mechanical and chemical interactions. The mortality increases if rebleeding occurs. In the aortic tear model in swine, hemorrhage volume and the mortality increase from effective restoration of the arterial pressure. The mortality vs. amount of fluid curve is U-shaped with higher mortality at either end. Without any fluid at all, irreversible shock causes death provided the hemorrhage is sufficiently large. Crystalloid fluid administered in a 3 : 1 proportion to the amount of lost blood initiates serious rebleeding. Hypertonic saline 7.5% in 6% dextran 70 (HSD) also provokes rebleeding resulting in higher mortality in the recommended dosage of 4 ml/kg. Uncontrolled hemorrhage models in rats, except for the ‘cut-tail’ model, confirm the results from swine. To avoid rebleeding, fluid programs should not aim to fully restore the arterial pressure, blood flow rates, or blood volume. For a hemorrhage of 1000 ml, computer simulations show that deliberate hypovolemia (−300 ml) would be achieved by infusing 600–750 ml crystalloid fluid over 20–30 min or 100 ml of HSD over 10–20 min in an adult male

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Section: Anesthesia and Fluid Volumementioning

confidence: 94%

Section: Anesthesia and Fluid Volumementioning

confidence: 96%

Section: Pathophysiologymentioning

confidence: 99%

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Fluid therapy in uncontrolled hemorrhage – what experimental models have taught us

Hahn

2012

Acta Anaesthesiol Scand

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“…36 Several authors advocate resuscitation at the scene of injury. 37,38 Several others criticize it. 34,39,40 The major concern of the latter authors lies in the expectation to initiate volume expansion before controlling a possible source of bleeding, through vascular access and infusion of volume expanders.…”

Section: Transport Prehospitalmentioning

confidence: 99%

Avaliação e transporte da criança traumatizada

Schvartsman

Carrera²,

Abramovici³

2005

J. Pediatr. (Rio J.)

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Suggested citation: Schvartsman C, Carrera R, Abramovici S. Initial assessment and transportation of an injured child. J Pediatr (Rio J). 2005;81(5 Suppl):S223-S229. AbstractObjectives: Since trauma has a great impact on mortality and preventable morbidity among children and adolescents, in addition to its social consequences, the aim of this study is to evaluate peculiarities regarding prehospital, in-hospital, and interhospital assessment of injured pediatric patients. Sources of data:The Cochrane database was searched for systematic reviews and controlled trials, the MEDLINE and LILACS databases were used for the last 5 years, and review of older reference sections in significant publications using trauma, pediatric trauma, primary survey, secondary survey, in-hospital assessment, prehospital and transportation as keywords.Summary of the findings: There are different strategies that constitute the systematic assessment of the injured pediatric patient. Nevertheless, almost all strategies involve knowing the peculiarities about the pediatric population, with regard to age, to the growth and development process, and finally, to the minimally acceptable and available resources. Conclusions:The most important principle is to do no further harm. If the peculiarities about airway maintenance, ventilation, circulation with hemorrhage control, disability, exposure up to secondary survey and preparation of prehospital and interhospital transportation are properly taken care of, better results will certainly be obtained.J Pediatr (Rio J). 2005;81(5 Suppl):S223-S229: Trauma, pediatric trauma, primary survey, secondary survey, inhospital assessment, prehospital and interhospital transportation.

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“…A tentativa de estabilização hemodinâmica do indivíduo traumatizado pelas equipes de atendimento pré-hospitalar aumenta o tempo no local da cena e, conseqüentemente, o tempo global do atendimento pré-hospitalar 36 . Diversos autores defendem a reanimação na cena 37,38 . Outros tantos criticam-na 34,39,40 .…”

Section: Pré-hospitalarunclassified

Initial assessment and transportation of an injured child

Schvartsman¹,

Carrera²,

Abramovici³

2005

J Pediatr (Rio J)

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Como citar este artigo: Schvartsman C, Carrera R, Abramovici S. Avaliação e transporte da criança traumatizada. J Pediatr (Rio J). 2005;81(5 Supl):S223-S229. AbstractObjectives: Since trauma has a great impact on mortality and preventable morbidity among children and adolescents, in addition to its social consequences, the aim of this study is to evaluate peculiarities regarding prehospital, in-hospital, and interhospital assessment of injured pediatric patients. Sources of data:The Cochrane database was searched for systematic reviews and controlled trials, the MEDLINE and LILACS databases were used for the last 5 years, and review of older reference sections in significant publications using trauma, pediatric trauma, primary survey, secondary survey, in-hospital assessment, prehospital and transportation as keywords.Summary of the findings: There are different strategies that constitute the systematic assessment of the injured pediatric patient. Nevertheless, almost all strategies involve knowing the peculiarities about the pediatric population, with regard to age, to the growth and development process, and finally, to the minimally acceptable and available resources. Conclusions:The most important principle is to do no further harm. If the peculiarities about airway maintenance, ventilation, circulation with hemorrhage control, disability, exposure up to secondary survey and preparation of prehospital and interhospital transportation are properly taken care of, better results will certainly be obtained.J Pediatr (Rio J). 2005;81(5 Supl):S223-S229: Trauma, pediatric trauma, primary survey, secondary survey, in-hospital assessment, prehospital and interhospital transportation. ResumoObjetivos: Devido ao impacto determinado pelo trauma na população infanto-juvenil no que diz respeito à mortalidade, morbidade e conseqüências sociais geradas, nossos objetivos concentram-se nas peculiaridades da avaliação pré-hospitalar, em ambiente hospitalar e ainda durante o transporte do paciente traumatizado pediátrico. Fontes de dados:Pesquisa eletrônica realizada nas bases Cochrane para revisões sistemáticas e estudos controlados, MEDLINE e LILACS nos últimos 5 anos e revisão de referências anteriores em publicações significativas, utilizando as seguintes palavras-chave: trauma, trauma pediátrico, exame primário, exame secundário, atendimento hospitalar, transporte pré-hospitalar e inter-hospitalar.Síntese dos dados: Diferentes estratégias compõem a sistematização do atendimento de crianças e adolescentes traumatizados. Entretanto, quase todas comportam a necessidade de conhecer as particularidades da população a ser tratada, no que diz respeito à idade, ao processo de crescimento e desenvolvimento e, finalmente, compondo o atendimento com os recursos minimamente aceitáveis e disponí-veis.Conclusões: O princípio de maior importância diz respeito a não determinar lesão adicional. Mantendo a visão sistemática das diferentes peculiaridades quanto à abordagem das vias aéreas, ventilação, circulação com controle de hemorragias, e...

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The Effects of Varying Fluid Volume and Rate of Resuscitation during Uncontrolled Hemorrhage

Abstract: Rapid infusion of moderate volume of isotonic saline improved survival in uncontrolled hemorrhage. Extreme volumes, infused rapidly, also resulted in higher survival rates compared with those observed in nonresuscitated rats.

Cited by 44 publications

References 21 publications

Fluid therapy in uncontrolled hemorrhage – what experimental models have taught us

Fluid therapy in uncontrolled hemorrhage – what experimental models have taught us

Avaliação e transporte da criança traumatizada

Initial assessment and transportation of an injured child

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