Hypertonic saline infusion with or without dextran 70 in the reperfusion phase of experimental acute limb ischaemia

Abstract

To study the efficacy of hypertonic fluid therapy on central haemodynamics, leg blood flow, and skeletal muscle metabolism at reperfusion after subtotal bilateral limb ischaemia. Prospective, randomised, controlled study, in pigs (n = 24). Bilateral limb ischaemia was induced (aortic balloon catheter) and central haemodynamics, peripheral blood flow-thoracic fluid content, blood chemistry, and skeletal muscle metabolite levels were monitored. After 235 min of ischaemia infusion of normal 0.9% saline (NS), hypertonic 7.5% saline (HS), or HS in 6% dextran 70 (HSD) was started. Five minutes later the aortic balloon was deflated and the haemodynamic and metabolic alterations were studied for 180 min after reflow. Aortic occlusion resulted in haemodynamic alterations, reduced limb perfusion and metabolic changes indicative of tissue ischaemia. The haemodynamic support prior to, and following, deflation of the aortic balloon was more efficient for HS and HSD than for NS. Lactate clearance and restitution of high energy phosphagen levels in skeletal muscle were faster and more pronounced in the HS and HSD groups. Small-volume hypertonic saline, especially in combination with 6% dextran 70, will effectively reverse limb ischaemia induced haemodynamic and tissue metabolic disturbances.