Abstract
ObjectiveThe aim of this study was to compare the effects of hypotensive and normotensive resuscitation with a novel combination of fluids via lactate Ringer’s solution (LRS), 6% hydroxyethyl starch 130/0.4 solution (HES), and 7.5% hypertonic saline solution (HSS) at early stage of uncontrolled hemorrhagic shock (UHS) before hemostasis.MethodsNew Zealand white rabbits (n = 32) underwent UHS by transecting the splenic parenchyma, followed by blood withdrawal via the femoral artery to target mean arterial pressure (MAP) of 40–45 mmHg. Animals were distributed randomly into 4 groups (n = 8): in group Sham, sham operation was performed; in group HS, UHS was untreated; in group HS-HR, UHS was treated by hypotensive resuscitation with HSS and LRS+HES (ratio of 2∶1) to MAP of 50–55 mmHg; in group HS-NR, UHS was treated by normotensive resuscitation with HSS and LRS+HES (ratio of 2∶1) to MAP of 75–80 mmHg. Outcomes of hemodynamics, inflammatory and oxidative response, and other metabolic variables were measured and the histopathological studies of heart, lung and kidney were performed at the end of resusucitation.ResultsHypotensive resuscitation with the novel combination of fluids for UHS rabbits decreased blood loss, maintained better stabilization of hemodynamics, and resulted in relatively higher hematocrit and platelet count, superior outcomes of blood gas, and lower plasma lactate concentration. Besides, hypotensive resuscitation attenuated the inflammatory and oxidative response significantly in UHS rabbits.ConclusionHypotensive resuscitation with the novel combination of fluids via HSS and LRS+HES (ratio of 2∶1) has an effective treatment at early stage of UHS before hemostasis.
Highlights
Traumatic hemorrhagic shock remains a major cause of disability and death due to a life-threatening loss of blood
The heparinized (50 U/ml) arterial line containing a calibrated pressure transducer, was directly connected to a data-acquisition system (BL-420F, Chengdu Taimeng Scientific Techonology, Inc.) After anesthesia and blood vessel cannulation, rabbits (n = 32, 8/group) were distributed randomly: in group Sham, sham operation was performed; in group HS, uncontrolled hemorrhagic shock (UHS) was untreated; in group HS-HR, UHS was treated by hypotensive resuscitation with hypertonic saline solution (HSS) (4 ml/kg) and lactate Ringer’s solution (LRS)+hydroxyethyl starch 130/0.4 solution (HES) to mean arterial pressure (MAP) of 50–55 mmHg; in group HS-NR, UHS was treated by normotensive resuscitation with HSS (4 ml/kg) and LRS+HES to MAP of 75–80 mmHg (Fig. 1)
According to the data-acquisition system, the range of normal MAP in rabbits was between 76.29 mmHg and 95.79 mmHg
Summary
Traumatic hemorrhagic shock remains a major cause of disability and death due to a life-threatening loss of blood. Various strategies of fluid resuscitation have been developed in response to UHS before hemostasis. Normotensive resuscitation is to use large volume of fluids to restore normal blood pressure. This method can recover blood pressure rapidly, but may cause severe hemodilution, and coagulation disturbance, resulting in an increase in blood loss and mortality [2]. The concept of hypotensive resuscitation has been raised decades before hemostasis. This strategy can be successful in maintaining desired perfusion while not worsening blood loss.
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