Effects Of Volume Replacement Research Articles

Effect of volume replacement during combined experimental hemorrhagic shock and traumatic brain injury in prostanoids, brain pathology and pupil status.

Traumatic brain injury (TBI) is the main cause of trauma-related deaths. Systemic hypotension and intracranial hypertension causes cerebral ischemia by altering metabolism of prostanoids. We describe prostanoid, pupilar and pathological response during resuscitation with hypertonic saline solution (HSS) in TBI. Method Fifteen dogs were randomized in three groups according to resuscitation after TBI (control group; lactated Ringer's (LR) group and HSS group), with measurement of thromboxane, prostaglandin, macroscopic and microscopic pathological evaluation and pupil evaluation.Result Concentration of prostaglandin is greater in the cerebral venous blood than in plasma and the opposite happens with concentration of thromboxane. Pathology revealed edema in groups with the exception of group treated with HSS.Discussion and conclusion There is a balance between the concentrations of prostaglandin and thromboxane. HSS prevented the formation of cerebral edema macroscopically detectable. Pupillary reversal occurred earlier in HSS group than in LR group.

Retraction Note: Volume therapy in the critically ill: is there a difference?

Objective: There are still several concerns about the extensive and prolonged use of hydroxyethylstarch solution (HES) in critically ill patients. The effects of volume replacement with HES over 5 days on hemodynamics, laboratory data, and organ function were compared with volume therapy using human albumin (HA). Design: Prospective, randomized study. Setting: Clinical investigations on a surgical intensive care unit (ICU) of a university hospital. Patients: 150 traumatized patients (injury severity score > 15) and 150 postoperative patients with sepsis were analyzed. Interventions: Either 10 % low-molecular weight HES (HES-trauma, n = 75; HES-sepsis, n = 75) or 20 % HA (HA-trauma, n = 75; HA-sepsis, n = 75) was given for 5 days to maintain the pulmonary capillary wedge pressure (PCWP) between 12 and 15 torr. The entire management of therapy of the patients was performed by physicians who were not involved in the study and blinded to the infusion regimen. Measurements and results: In addition to extensive cardiorespiratory monitoring, several routine laboratory parameters for assessing pulmonary, renal, hepatic, and coagulation function were analyzed from arterial blood samples on the day of admission to the ICU and on the day of sepsis diagnosis, respectively (“baseline” value) and daily over the following 5 days. Mortality during and after the study did not differ significantly between the infusion groups. There were also no differences between the incidence of pulmonary, renal, or hepatic failure in the two subgroups. Mean arterial pressure, heart rate, and PCWP were similar in both subgroups, whereas cardiac index, oxygen delivery index, oxygen consumption index, and the ratio between the partial pressure of oxygen in arterial blood and fractional inspired oxygen were higher in the HES- than in the HA-treated groups. Standard coagulation parameters did not differ, albumin concentration increased significantly in both HA groups, and lactate concentrations decreased only in the HES-sepsis patients (from 2.8 ± 0.5 to 1.5 ± 0.4 mg/dl). Volume replacement using albumin was significantly (p < 0.001) more costly than therapy with HES. Conclusions: Volume therapy with 10 % HES for 5 days in the ICU patient showed no disadvantages compared with an infusion regimen using 20 % albumin. Volume replacement using HES may even be associated with improved hemodynamics. HES appears to be a valuable and significantly cheaper alternative to albumin – even for prolonged volume therapy in the critically ill patient.

Cytokine levels evaluation during acute isovolemic anemia

To date there is poor evidence that documents the benefit of red blood cell transfusion on clinical outcome. Acceptance of a lower transfusion trigger in the perioperative period requires detailed information regarding the effects of volume replacement in different organs and systems. Since fluids can have a widely divergent impact on the immune response, this study was undertaken to determine the cytokine levels in a model of acute isovolemic anemia (AIA) with hydroxyethyl starch (HES) and gelatin (GEL).

Blood Loss and Transcapillary Refill in Uncontrolled Treated Hemorrhage in Dogs

OBJETIVE:This study evaluated retroperitoneal hematomas produced by bilateral injury of iliac arteries (uncontrolled hemorrhage), blood volume loss, transcapillary refill, the effects of volume replacement on retroperitoneal bleeding and the hemodynamic changes with and without treatment.METHODS:Initial blood volume was determined with Tc99m-labelled red cells, and bleeding was evaluated by means of a portable scintillation camera positioned over the abdomen. Previously splenectomized mongrel dogs (16.8 ± 2.2 kg) were submitted to hemorrhage for 30 minutes and randomized into three groups: I - no treatment (n=7); II - treatment with 32 mL/kg of Lactated Ringer’s for three to five minutes (n=7); and III - treatment with 4 mL/kg of 7.5% NaCl plus 6.0% dextran 70 for three to five minutes (n=7). They were studied for an additional 45 minutes.RESULTS:Volume replacement produced transitory recovery in hemodynamic variables, including mean pulmonary artery pressure, pulmonary capillary wedge pressure and cardiac index, with significant increase in dogs treated with 32 mL/kg of Lactated Ringer’s and 7.5% NaCl plus 6.0% dextran 70 (p<0.001, against no treatment), along with a decrease (p<0.001) in the systemic vascular resistance index. Groups II and III had significant initial decreases in hematocrit and hemoglobin. The treated dogs (groups II and III) presented rebleeding, which was greater during treatment with 32 mL/kg of Lactated Ringer’s (group II).CONCLUSIONS:Despite the rebleeding observed in treated groups, the utilization of hypertonic saline solution with dextran proved to be effective in the initial reanimation, producing evident transcapillary refill, while the Lactated Ringer’s solution produced capillary extravasation and was ineffective in the initial volume replacement in this model of uncontrolled hemorrhage.

The Effect of Volume Replacement on Serum Protein Concentration During Cardiopulmonary Bypass

Although controversy exists concerning the optimal total protein and colloid osmotic pressure that should be maintained during cardiopulmonary bypass (CPB), the primary volume expanders remain albumin and 6% hetastarch. The purpose of this study was to quantify the effect of adding boluses of volume replacement agents under various conditions to total serum protein values during CPB. A standard CPB circuit was utilized in eight 45-kg swine that had a priming volume (physiologic saline solution) of 2309 ± 245 mL. Volumetric alterations occurred throughout the CPB period by the addition of combinations of physiologic saline solution, 6% hetastarch or 5% swine albumin. Pre- and postadministration samples were assayed for total serum protein, total protein, and albumin throughout the CPB period and at pre- and postvolume administration times. There was a significant decline in total serum protein with the initiation of CPB (6.14 ± 0.49 g/dL vs. 3.40 ± 0.43 g/dL, p &lt;.0001). Addition of 12.5 g of swine albumin (N = 5) to two different swine increased total serum protein significantly when compared to adding 500 mL of 6% hetastarch (N = 6) (swine albumin 12.4 ± 6.3% vs. hetastarch 3.3 ± 2.1%, p &lt;.005). A reduction in total serum protein occurred after hemodilution with varying amount of physiologic saline solution: 250–450 mL (7.4 ± 4.5%), 451–650 mL (9.6 ± 5.6%), and 651–1050 mL (19.4 ± 4.0%). In summary, knowledge of total serum protein concentration and estimated circulating blood volume can be used to guide albumin and hetastarch administration following hemodilution.

Effects of volume replacement on plasma volume and albumin escape rate in a porcine model of fecal peritonitis

Effects of volume replacement on plasma volume and albumin escape rate in a porcine model of fecal peritonitis

Effects of fluid resuscitation with recombinant human serum albumin solution on maintaining hepatic energy metabolism in hemorrhagic shock rabbits.

The objective of this study was to examine the effects of volume replacement with recombinant human serum albumin (rHSA), which was developed to reduce the consumption of human blood derivatives, on maintaining hepatic energy metabolism. Hemorrhagic shock with a mean blood pressure of 50 mmHg was induced within 20 min and maintained for 60 min by Wiggars' method in rabbits. Fluid resuscitation replacing two thirds of the blood withdrawn with plasma-derived 5% human serum albumin (pHSA; n = 7) or rHSA (n = 10), or replacing double the volume of blood withdrawn with lactated Ringer's solution (n = 7) was completed within 20 min, and observed for 120 min. No significant differences were observed in the blood pressures, blood gas analyses, blood counts, biochemical parameters (e.g., alanine aminotransferase, lactate dehydrogenase, creatine kinase, blood urea nitrogen, creatinine) or blood glucose levels among the three groups. There were also no significant differences in the parameters of hepatic energy metabolism such as blood pyruvate and lactate levels and their ratios, ketone body concentrations and their ratios, and hepatic tissue energy charge levels among the experimental groups. It is suggested that volume replacement with rHSA, like pHSA, is able to maintain hemodynamics and organ function in hemorrhagic shock, particularly hepatic energy metabolism.

Liver metabolic effects of intestinal shock and naloxone treatment in the rat.

The liver metabolic response of rats following a standardized intestinal shock, induced by applying a pressure of 120 cm water on the mesenteric vessels for 60 min, was studied. Immediately prior to the release of the pressure on the vessels saline or naloxone was given either as a single injection or as a continuous infusion. After the reperfusion of the intestine no early disturbances in liver metabolism were found as evidenced from the ATP, glucose and lactate levels in liver biopsies taken 15 min following reflow. Within 60 min of reflow reduction of ATP and increases of glucose and lactate levels occurred. There were no major hemodynamic or liver metabolic differences between saline- and naloxone-treated shocked rats. When saline or naloxone was given as a continuous infusion, the changes in liver metabolism were, however, less severe than those observed in the single injection situation pointing toward a non-specific effect of volume replacement rather than a blockade of opioid receptors. Hepatic hypoxia and/or cellular effects of "shock factors" could be mechanisms of pathophysiologic importance for the disturbed liver metabolism in this shock model.