Volume Kinetics of Ringer's Solution in Hypovolemic Volunteers

Drobin, Dan; Hahn, Robert G.

doi:10.1097/00000542-199901000-00013

Cited by 147 publications

(175 citation statements)

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“…However, BL has the opposite effect. The reduction in circulating blood volume causes fluid to shift from the extravascular space to the intravascular space, resulting in hemodilution (7,27,39) and a lower blood viscosity (3). The divergent hematocrit and viscosity responses to LBNP and BL may differentially influence coagulation responses during these two protocols, despite similar hemodynamic responses.…”

Section: Our Study Provides Noteworthy Data That Directly Compare Blomentioning

confidence: 99%

Coagulation changes during lower body negative pressure and blood loss in humans

Helmond

Johnson

Curry

et al. 2015

American Journal of Physiology-Heart and Circulatory Physiology

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van Helmond N, Johnson BD, Curry TB, Cap AP, Convertino VA, Joyner MJ. Coagulation changes during lower body negative pressure and blood loss in humans. Am J Physiol Heart Circ Physiol 309: H1591-H1597, 2015. First published September 9, 2015; doi:10.1152/ajpheart.00435.2015.-We tested the hypothesis that markers of coagulation activation are greater during lower body negative pressure (LBNP) than those obtained during blood loss (BL). We assessed coagulation using both standard clinical tests and thrombelastography (TEG) in 12 men who performed a LBNP and BL protocol in a randomized order. LBNP consisted of 5-min stages at 0, Ϫ15, Ϫ30, and Ϫ45 mmHg of suction. BL included 5 min at baseline and following three stages of 333 ml of blood removal (up to 1,000 ml total). Arterial blood draws were performed at baseline and after the last stage of each protocol. We found that LBNP to Ϫ45 mmHg is a greater central hypovolemic stimulus versus BL; therefore, the coagulation markers were plotted against central venous pressure (CVP) to obtain stimulus-response relationships using the linear regression line slopes for both protocols. Paired t-tests were used to determine whether the slopes of these regression lines fell on similar trajectories for each protocol. Mean regression line slopes for coagulation markers versus CVP fell on similar trajectories during both protocols, except for TEG ␣°angle (Ϫ0.42 Ϯ 0.96 during LBNP vs. Ϫ2.41 Ϯ 1.13°/mmHg during BL; P Ͻ 0.05). During both LBNP and BL, coagulation was accelerated as evidenced by shortened R-times (LBNP, 9.9 Ϯ 2.4 to 6.2 Ϯ 1.1; BL, 8.7 Ϯ 1.3 to 6.4 Ϯ 0.4 min; both P Ͻ 0.05). Our results indicate that LBNP models the general changes in coagulation markers observed during BL. blood coagulation; hemorrhage; lower body negative pressure; blood coagulation tests; humans; central hypovolemia NEW & NOTEWORTHYOur study provides noteworthy data that directly compare blood coagulation activation induced by lower body negative pressure to those observed during blood loss in conscious humans.HEMORRHAGE IS ONE OF THE LEADING causes of accidental death (1) and is the leading cause of death on the battlefield (8, 9). Activation of the coagulation system is vital following a hemorrhagic injury to reduce the risk of exsanguination. Consequently, studying the activation of the coagulation system during blood loss (BL) is of upmost importance so new therapies and treatment algorithms, such as fluid resuscitation, can be developed. However, using invasive methods to experimentally induce BL is challenging to perform in humans.Lower body negative pressure (LBNP) is a technique that is used as a noninvasive surrogate to study many of the physiological responses to BL (4, 15, 18). LBNP sequesters circulating blood in the lower body, thereby reducing central blood volume and mimicking hemodynamic responses generated during BL (4,15,18). However, it is unclear if markers of coagulation system activation respond similarly during these protocols. Reductions in central blood volume by LBNP (38) ...

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Section: Our Study Provides Noteworthy Data That Directly Compare Blomentioning

confidence: 99%

Coagulation changes during lower body negative pressure and blood loss in humans

Helmond

Johnson

Curry

et al. 2015

American Journal of Physiology-Heart and Circulatory Physiology

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“…Simulations based on data from Drobin & Hahn 49 illustrate the summary effect of distribution and capillary refill on the plasma volume expansion in normotensive adult male volunteers who had 900 ml of blood removed within 10-15 min (controlled hemorrhage). Here, the practice of infusing 3 times the hemorrhage volume with Ringer´s solution (3:1 rule) over 30 minutes is shown to create marked hypervolemia (Fig.…”

Section: Volume Kinetic Analysesmentioning

confidence: 99%

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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“…When the two-volume model is statistically justified, the size of V1 after infusion of Ringer' s acetate solution is usually quite close to the expected plasma volume. 3,5,8,9 V1 is reduced in hypovolemia and in proportion to the amount of lost blood. It is interesting to note that the size of V2 is only about two-thirds that of the interstitial fluid space (as indicated by radioactive tracers), suggesting that the entire extracellular fluid space is not expanded by intravenous fluid.…”

Section: Basic Findingsmentioning

confidence: 99%

“…To illustrate its significance, the results for patients and controls can be entered into either (1) a simulation program that illustrates the outcome of any infusion rate or duration of infusion; or (2) a nomogram that shows both the types of alternative fluid regimens that can be used to reach the same plasma dilution and the rates at which the fluids should be infused in order to maintain steady state. 6,8 Volume kinetics may also provide information on fluid equivalency, that is to say how much of one fluid corresponds to another.…”

Section: Volume Kinetics At Work Surgerymentioning

confidence: 99%

Volume Kinetics – Pharmacokinetics for Fluids

Svensén

2002

Transfus Alt Transfus Med

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Fluid therapy is a main component in the management of critically ill patients.Unfortunately, a considerable number of patients receive excessive fluid therapy that results in volume overload and organ dysfunction. There is an obvious need for a more refined scientific method to replace the more or less precise "rules-ofthumb."A new approach to fluid therapy-volume kinetics-is the first adaptation of pharmacokinetic theory that allows the behavior of fluid volumes administered during intravenous therapy to be analyzed and simulated.

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Volume Kinetics of Ringer's Solution in Hypovolemic Volunteers

Abstract: The dilution of the blood and the retention of infused Ringer's solution in the body increases in the presence of hypovolemia, which can be attributed chiefly to a reduction of the elimination rate constant.

Cited by 147 publications

References 18 publications

Coagulation changes during lower body negative pressure and blood loss in humans

Coagulation changes during lower body negative pressure and blood loss in humans

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

Volume Kinetics – Pharmacokinetics for Fluids

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