The next generation in shock resuscitation

Moore, Frederick A.; McKinley, Bruce A.; Moore, Ernest E.

doi:10.1016/s0140-6736(04)16415-5

Cited by 277 publications

(188 citation statements)

References 107 publications

Supporting

Mentioning

166

Contrasting

Unclassified

Order By: Relevance

“…5,11 How to achieve these properties has been a subject of controversy, particularly regarding the viscosity, colloid osmotic pressure (COP) and the type of colloid which ensure adequate organ perfusion. [12][13][14] The objective of the study was to determine whether a currently available and relatively high viscosity plasma expander could reinstate systemic/microvascular conditions from a severe experimental hemorrhagic shock model when used in conjunction with HTS in a moderate volume resuscitation strategy. To achieve this objective, our experimental hamster model was subjected to a hemorrhage of 50% of blood volume (BV) followed by one hour hypovolemic shock.…”

Section: Introductionmentioning

confidence: 99%

Increased plasma viscosity prolongs microhemodynamic conditions during small volume resuscitation from hemorrhagic shock

2008

View full text Add to dashboard Cite

Systemic and microvascular hemodynamic responses to hemorrhagic shock resuscitation with hypertonic saline (HTS, 7.5% NaCl) followed with a small volume of plasma expander were studied in the hamster window chamber model to determine the role of plasma expander viscosity in the acute resuscitation outcome. Moderate hemorrhagic shock was induced by arterial controlled bleeding of 50% of blood volume (BV) and the hypovolemic state was maintained for one hour. Volume restitution was performed by infusion of HTS, 3.5% of BV followed by 10% of BV plasma expanders. Resuscitation was followed for 90 min. The experimental groups were named based on the plasma expanders infused after the HTS, namely: [Hextend], Hextend® (6% Hetastarch 670 kDa in lactated electrolyte solution, 4 cp), [Hextend+V], Hextend® with viscosity enhanced by the addition of 0.4% alginate, 8 cp, and [NVR] no volume resuscitation as control group. Measurement of systemic parameters, microvascular hemodynamics and capillary perfusion were performed during hemorrhage, shock and resuscitation. Restitution with Hextend yielded the higher mean arterial pressure (MAP), followed by Hextend+V and NVR. Increasing plasma viscosity did not increase peripheral vascular resistance. Functional capillary density (FCD) was higher for Hextend+V than Hextend and NVR. The level of restoration of acid-base balance correlated with microvascular perfusion and was significantly improved with Hextend+V when compared to Hextend and NVR. These results suggest the importance of restoration of blood rheological properties through enhancing plasma viscosity, influencing the re-establishment of microvascular perfusion during small volume resuscitation from hemorrhagic shock.

show abstract

Section: Introductionmentioning

confidence: 99%

Increased plasma viscosity prolongs microhemodynamic conditions during small volume resuscitation from hemorrhagic shock

2008

View full text Add to dashboard Cite

show abstract

“…They became popular during the Vietnam War, when blood became unavailable. Initially their use was thought to be associated with better survival [13]. However, their use soon became associated with the "shocked lung", which later on was defined as ARDS [18].…”

Section: Crystalloids: 09% Isotonic Saline and Lactate Ringersmentioning

confidence: 99%

“…All of the above would seem to favour IS, but conflicting results from various studies make it almost impossible to draw the definite conclusions. Some studies advise LR as the primary resuscitation crystalloid, having fewer reported complications with its use in trauma [10,13,17]. Interestingly, no association was found between LR and the degree of acidosis [26].…”

Section: Crystalloids: 09% Isotonic Saline and Lactate Ringersmentioning

confidence: 99%

“…In contrast, Coats et al, revealed the HSD doi: 10.7243/2052-6229-1-1 procoagulant effect at 10% with subsequent rapid increase in deranged clotting at 15% dilution [34]. Rotstein et al, suggested that a small bolus of HSD can be beneficial in haemorrhagic shock, but other research group found that it is associated with a risk of inducing splanchnic ischaemia [13]. Similarly to HTS, the evidence shows that HSD can improve haemodynamic parameters and reduce intracranial pressure [35].…”

Section: Hypertonic Saline With Dextran (Hsd)mentioning

confidence: 99%

“…However, several studies found this to be harmful, because it exacerbates the lethal triad (acidosis, coagulopathy and hypothermia) and shock induced inflammatory response [10][11][12]. This subsequently leads to profound systemic and cellular complications, which cause adult respiratory distress syndrome (ARDS), multi organ dysfunction syndrome (MODS) and death [12,13].…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Impact of crystalloids and colloids on coagulation cascade during trauma resuscitation-a literature review

Kaczynski¹,

Wilczynska²,

Hilton³

et al. 2013

Emerg Med Health Care

View full text Add to dashboard Cite

Background: During resuscitation trauma patients receive various intravenous fluids, which can exacerbate coagulopathy and haemorrhage further. This led to the introduction of the damage control resuscitation, which advocates minimal intravenous fluids use. However, some fluid may be required in uncontrolled haemorrhage or when blood products are not immediately available. Furthermore, questions regarding the type and volume of the administered fluids remain still unanswered. Methods: Review of literature. Results: Crystalloids such as 0.9% Isotonic Saline and Lactate Ringers can cause either a hypercoagulable (lower dilutions) or hypocoagulable (higher dilutions) derangements. Hypertonic Saline (7.5%) leads to more pronounced coagulation abnormalities when compared with 0.9% Isotonic Saline. The effects of the 7.5% Hypertonic Saline combined with 6 % Dextran 70 are controversial. Some authors reported significant clotting abnormalities, but others found an improvement in the haemodynamic parameters. The evidence on human albumin solution use in trauma is very limited and suggests a procoagulant effect at lower dilutions. Gelofusine even with smaller volumes leads to pronounced coagulation abnormalities. All Dextrans (40 and 70) cause significant hypocoagulability at lower dilutions. Similarly lower molecular starches demonstrate a definite hypocoagulable effect. Conclusions: A literature review has also indicated that none of the studies demonstrated survival or outcome benefit associated with a particular type and volume of administered intravenous fluids. The results are controversial and further research is needed to clarify this issue.

show abstract

The Prospective, Observational, Multicenter, Major Trauma Transfusion (PROMMTT) Study

et al. 2013

View full text Add to dashboard Cite

The next generation in shock resuscitation

Cited by 277 publications

References 107 publications

Increased plasma viscosity prolongs microhemodynamic conditions during small volume resuscitation from hemorrhagic shock

Increased plasma viscosity prolongs microhemodynamic conditions during small volume resuscitation from hemorrhagic shock

Impact of crystalloids and colloids on coagulation cascade during trauma resuscitation-a literature review

The Prospective, Observational, Multicenter, Major Trauma Transfusion (PROMMTT) Study

Contact Info

Product

Resources

About