Abstract
ObjectiveThe goal of this study was to investigate the effect of hypertonic saline with 6% Dextran-70 (HSD) resuscitation on organ damage and the resuscitation efficiency of the combination of HSD and lactated ringers (LR) in a model of hemorrhage shock in dogs.MethodsBeagles were bled to hold their mean arterial pressure (MAP) at 50±5 mmHg for 1 h. After hemorrhage, beagles were divided into three groups (n = 7) to receive pre-hospital resuscitation for 1 h (R1): HSD (4 ml/kg), LR (40 ml/kg), and HSD+LR (a combination of 4 ml/kg HSD and 40 ml/kg LR). Next, LR was transfused into all groups as in-hospital resuscitation (R2). After two hours of observation (R3), autologous blood was transfused. Hemodynamic responses and systemic oxygenation were measured at predetermined phases. Three days after resuscitation, the animals were sacrificed and tissues including kidney, lung, liver and intestinal were obtained for pathological analysis.ResultsAlthough the initial resuscitation with HSD was shown to be faster than LR with regard to an ascending MAP, the HSD group showed a similar hemodynamic performance compared to the LR group throughout the experiment. Compared with the LR group, the systemic oxygenation performance in the HSD group was similar but showed a lower venous-to-arterial CO2 gradient (Pv-aCO2) at R3 (p < 0.05). Additionally, the histology score of the kidneys, lungs and liver were significantly lower in the HSD group than in the LR group (p < 0.05). The HSD+LR group showed a superior hemodynamic response but higher extravascular lung water (EVLW) and lower arterial oxygen tension (PaO2) than the other groups (p < 0.05). The HSD+LR group showed a marginally improved systemic oxygenation performance and lower histology score than other groups.ConclusionsResuscitation after hemorrhagic shock with a bolus of HSD showed a similar hemodynamic response compared with LR at ten times the volume of HSD, but HSD showed superior efficacy in organ protection. Our findings suggest that resuscitation with the combination of HSD and LR in the pre-hospital setting is an effective treatment.
Highlights
Hemorrhagic shock is the leading cause of morbidity and mortality in trauma and military casualties
The initial resuscitation with hypertonic saline with 6% Dextran-70 (HSD) was shown to be faster than lactated ringers (LR) with regard to an ascending mean arterial pressure (MAP), the HSD group showed a similar hemodynamic performance compared to the LR group throughout the experiment
Resuscitation after hemorrhagic shock with a bolus of HSD showed a similar hemodynamic response compared with LR at ten times the volume of HSD, but HSD showed superior efficacy in organ protection
Summary
Hemorrhagic shock is the leading cause of morbidity and mortality in trauma and military casualties. Fluid resuscitation is one of the first essential treatments of severe hemorrhagic shock and may have significant effects on both early and late outcomes. Hypertonic saline dextran (HSD, 7.5% NaCl in 6% Dextran) has been confirmed to be a highly effective resuscitation solution for the treatment of life-threatening hemorrhage [1,2,3,4,5]. HSD has advantages when used for pre-hospital fluid resuscitation due to its high volume effect, limited edema formation, and marked reduction of baggage load for rescue forces [5, 7]. Small volume resuscitation fluids continue to be of interest to the military and limited volume resuscitation is becoming more common in the treatment of hemorrhage in the civilian community. HSD has been suggested as small volume expander for early hemorrhagic shock. HSD was still a popular resuscitation fluid in many countries
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