Abstract
AimThe aim of this study is to compare the effect of lactated ringer (LR), vasopressin (Vaso) or terlipressin (Terli) on uncontrolled hemorrhagic shock (UHS) in rats.Methods48 rats were divided into four treatment groups for UHS study. Vaso group was given bolus vasopressin (0.8 U/kg); the Terli group was given bolus terlipressin (15 mcg/kg); LR group was given LR and the sham group was not given anything. Mean arterial pressure (MAP), serum lactate level, plasma cytokine levels, lung injury and mortality are investigated for these different treatment groups.ResultsCompared with LR group, vasopressin and terlipressin-treated groups were associated with higher MAP, lowered mortality rates, less lung injury, lowered serum lactate level, less proinflammatory and more anti-inflammatory cytokine production at certain time points. Comparing between vasopressin and terlipressin treated groups, there is no statistical difference in mortality rates, lung injury, serum lactate level and cytokine level. However, there is a difference in the length of time in maintaining a restored level of MAP (80 to 110 mmHg). The terlipressin treated rats can maintain this restored level of MAP for 45 minutes, but the vasopressin treated rats can only maintain this restored level of MAP for 5 minutes before decreasing gradually to the MAP observed in LR group (40 mmHg).ConclusionEarly optimization of hemodynamics with terlipressin or vasopressin in an animal model of UHS was associated with improved hemodynamics and inflammatory cytokine profile than the LR control. Compared with vasopressin, terlipressin has the advantage of ease of use and sustained effects.
Highlights
Fluid resuscitation is a standard therapy for uncontrolled hemorrhage shock (UHS) but deciding when is the correct timing for fluid resuscitation is challenging
Mean arterial pressure (MAP) Serial measurements of mean (6SD) arterial pressure versus time plots are shown in Fig 1 & S1
In the Vaso group, the MAP soon rose as high as 120 mmHg in response to an intravenous injection of vasopressin, but the blood pressure could not be maintained and declined gradually to as low as the lactated ringer (LR) group after 50 min
Summary
Fluid resuscitation is a standard therapy for uncontrolled hemorrhage shock (UHS) but deciding when is the correct timing for fluid resuscitation is challenging. Both animal and clinical studies have revealed that attempting to achieve normal blood pressure by aggressive fluid resuscitation during uncontrolled hemorrhagic shock (UHS) increased mortality [1,2,3,4,5]. Aggressive fluid resuscitation in the presence of uncontrolled hemorrhage usually induces further blood loss, worsens acidosis, results in severe hemodilution, decreases oxygen delivery, and increases mortality [2,3,4,5]. Using adjunct vasopressors to raise blood pressure in the early course of hemorrhagic shock, appears as a reasonable strategy
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