Abstract
IntroductionPulmonary oedema and impairment of oxygenation are reported as common consequences of haemorrhagic shock and resuscitation (HSR). Surprisingly, there is little information in the literature examining differences in crystalloid type during the early phase of HSR regarding the development of pulmonary oedema, the impact on oxygenation and the haemodynamic response. These experiments were designed to determine if differences exist because of crystalloid fluid type in the development of oedema, the impact on oxygenation and the haemodynamic response to fluid administration in early HSR.MethodsTwenty anaesthetised swine underwent a grade V liver injury and bled without resuscitation for 30 minutes. The animals were randomised to receive, in a blinded fashion, either normal saline (NS; n = 10) or lactated Ringer's solution (LR; n = 10). They were then resuscitated with study fluid to, and maintained at, the preinjury mean arterial pressure (MAP) for 90 minutes.ResultsExtravascular lung water index (EVLWI) began to increase immediately with resuscitation with both fluid types, increasing earlier and to a greater degree with NS. A 1 ml/kg increase in EVLWI from baseline occurred after administartion of (mean ± standard error of the mean) 68.6 ± 5.2 ml/kg of normal saline and 81.3 ± 8.7 ml/kg of LR (P = 0.027). After 150 ml/kg of fluid, EVLWI increased from 9.5 ± 0.3 ml/kg to 11.4 ± 0.3 ml/kg NS and from 9.3 ± 0.2 ml/kg to 10.8 ± 0.3 ml/kg LR (P = 0.035). Despite this, oxygenation was not significantly impacted (Delta partial pressure of arterial oxygen (PaO2)/fraction of inspired oxygen (FiO2) ≤ 100) until approximately 250 ml/kg of either fluid had been administered. Animals resuscitated with NS were more acidaemic (with lower lactates), pH 7.17 ± 0.03 NS vs. 7.41 ± 0.02 LR (P < 0.001).ConclusionsThis study suggests that early resuscitation of haemorrhagic shock with NS or LR has little impact on oxygenation when resuscitation volume is less than 250 ml/kg. LR has more favourable effects than NS on EVLWI, pH and blood pressure but not on oxygenation.
Highlights
Pulmonary oedema and impairment of oxygenation are reported as common consequences of haemorrhagic shock and resuscitation (HSR)
A 1 ml/kg increase in Extravascular lung water index (EVLWI) from baseline occurred after administartion of 68.6 ± 5.2 ml/kg of normal saline and 81.3 ± 8.7 ml/kg of lactated Ringer's solution (LR) (P = 0.027)
This study suggests that early resuscitation of haemorrhagic shock with normal saline (NS) or LR has little impact on oxygenation when resuscitation volume is less than 250 ml/kg
Summary
Pulmonary oedema and impairment of oxygenation are reported as common consequences of haemorrhagic shock and resuscitation (HSR). There is little information in the literature examining differences in crystalloid type during the early phase of HSR regarding the development of pulmonary oedema, the impact on oxygenation and the haemodynamic response. Little data exist examining the differences in these crystalloid fluids during the early resuscitation phase as a determinant of the CO: cardiac output; EVLWI: extravascular lung water index; FiO2: fraction of inspired oxygen; GEDV: global end-diastolic volume; HR: heart rate; HSR: haemorrhagic shock and resuscitation; IL: interleukin; ITBV: intrathoracic blood volume; LR: lactated Ringer's solution; MAP: mean arterial pressure; NS: normal saline; PaCO2: partial pressure of arterial carbon dioxide; PaO2: partial pressure of arterial oxygen; PBV: pulmonary blood volume; PVPI: pulmonary vascular permeability index; SV: stroke volume; SVR: systemic vascular resistance; TNF: tumour necrosis factor. Little is known about the effects of the volume and type of crystalloid administered during the early resuscitation of haemorrhagic shock on these opposing factors and their impact on the formation of clinically significant amounts of EVLWI and the impact on oxygenation
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