Abstract
IntroductionWe sought to determine and compare the effects of vasopressin, fluid resuscitation and saline placebo on haemodynamic variables and short-term survival in an abdominal vascular injury model with uncontrolled haemorrhagic shock in pigs.MethodsDuring general anaesthesia, a midline laparotomy was performed on 19 domestic pigs, followed by an incision (width about 5 cm and depth 0.5 cm) across the mesenterial shaft. When mean arterial blood pressure was below 20 mmHg, and heart rate had declined progressively, experimental therapy was initiated. At that point, animals were randomly assigned to receive vasopressin (0.4 U/kg; n = 7), fluid resuscitation (25 ml/kg lactated Ringer's and 25 ml/kg 3% gelatine solution; n = 7), or a single injection of saline placebo (n = 5). Vasopressin-treated animals were then given a continuous infusion of 0.08 U/kg per min vasopressin, whereas the remaining two groups received saline placebo at an equal rate of infusion. After 30 min of experimental therapy bleeding was controlled by surgical intervention, and further fluid resuscitation was performed. Thereafter, the animals were observed for an additional hour.ResultsAfter 68 ± 19 min (mean ± standard deviation) of uncontrolled bleeding, experimental therapy was initiated; at that time total blood loss and mean arterial blood pressure were similar between groups (not significant). Mean arterial blood pressure increased in both vasopressin-treated and fluid-resuscitated animals from about 15 mmHg to about 55 mmHg within 5 min, but afterward it decreased more rapidly in the fluid resuscitation group; mean arterial blood pressure in the placebo group never increased. Seven out of seven vasopressin-treated animals survived, whereas six out of seven fluid-resuscitated and five out of five placebo pigs died before surgical intervention was initiated (P < 0.0001).ConclusionVasopressin, but not fluid resuscitation or saline placebo, ensured short-term survival in this vascular injury model with uncontrolled haemorrhagic shock in sedated pigs.
Highlights
We sought to determine and compare the effects of vasopressin, fluid resuscitation and saline placebo on haemodynamic variables and short-term survival in an abdominal vascular injury model with uncontrolled haemorrhagic shock in pigs
After 68 ± 19 min of uncontrolled bleeding, experimental therapy was initiated; at that time total blood loss and mean arterial blood pressure were similar between groups
There appears to be no evidence either for or against early or large amounts of intravenous fluid administration in uncontrolled haemorrhage [1,2]. These findings on fluids in uncontrolled haemorrhagic shock are inconclusive, the strategy of delaying fluid resuscitation must be deemed unconfirmed as well, because the only study to examine the efficacy of this approach yielded barely significant findings
Summary
We sought to determine and compare the effects of vasopressin, fluid resuscitation and saline placebo on haemodynamic variables and short-term survival in an abdominal vascular injury model with uncontrolled haemorrhagic shock in pigs. In porcine models of uncontrolled haemorrhagic shock after liver trauma, vasopressin was superior to fluid resuscitation, adrenaline (epinephrine), and saline placebo in terms of blood loss, haemodynamic variables, and survival [3,4,5]. In agreement with these experiments, vasopressin reduced blood loss and stabilized arterial blood pressure in patients who had suffered traumatic or nontraumatic injury with haemorrhagic shock that was refractory to catecholamines [6,7,8,9]. Beneficial effects of vasopressin may seem realistic in a parenchymatic organ such as the liver, pronounced vascular injury may impose (page number not for citation purposes)
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