Rapid Volume Replacement Research Articles

Normothermic rapid volume replacement in traumatic hypovolemia. A prospective analysis using a new device.

Inadequate infusion flow rates and hypothermia are significant problems encountered in managing traumatic hemorrhagic shock. The Rapid Solution Administration Set (RSAS) allows normothermic volume restoration at flow rates of up to 2200 mL/min via a single peripheral venipuncture. The RSAS was utilized in 33 consecutive multiple-trauma patients with a mean trauma score (TS) of 6.8. Admission systolic blood pressure averaged 66.9 mm Hg. A mean of 5692 mL of packed red blood cells, 5515 mL of blood products, and 12,052 mL of crystalloid solution per patient was infused within 24 hours of admission mostly via the RSAS. Mortality was 45% at 24 hours following arrival and 61% overall. The mortality was 93.8% (15/16) in patients with a TS of 5 or less and 29.4% (5/17) in patients with a TS over 5. The initial postinfusion patient temperatures averaged 35.2 degrees C. All abnormal preinfusion coagulation values normalized within 24 hours in the survivors, and no significant complications occurred with the use of the RSAS. The RSAS seems to provide an uncomplicated means of normothermic volume replacement. The 24-hour survival in potentially salvageable patients may be improved. Its use in patients with lethal injuries (TS less than or equal to 3) requires further evaluation.

Normothermic rapid volume replacement for hypovolemic shock: an in vivo and in vitro study utilizing a new technique.

Hypovolemic shock secondary to intraoperative or traumatic hemorrhage requires urgent, aggressive resuscitation to achieve a successful outcome. Common difficulties encountered include the need for venous access, restoration of blood volume, and most important, maintenance of normothermia. The rapid solution administration set utilized in this study addresses the above limitations. Venous access is quickly accomplished by the percutaneous insertion of a large-bore catheter into the central venous system. The set requires only one central venous entry site for adequate fluid resuscitation. Expeditious restoration of blood volume is accomplished by gravity-induced infusion of crystalloids, colloids, and blood products at flow rates of up to 1,600 ml/minute. High flow rates are obtained by utilizing low-resistance filters and large-bore perfusion tubing. Avoidance of transfusion-induced hypothermia is addressed by incorporation of an extracorporeal heat exchanger into the administration set. The infusate temperature is maintained at 37 degrees C regardless of the administration rate or the initial fluid temperature. In vitro and canine in vivo testing demonstrated no significant hemolysis of the transfused blood and allowed maintenance of normothermia.

Normothermic rapid volume replacement for hypovolemic shock: An in vivo and in vitro study utilizing a new technique: Fried SJ, Satiani B, Zeeb P. J Trauma 1986; 26: 183–188

Normothermic rapid volume replacement for hypovolemic shock: An in vivo and in vitro study utilizing a new technique: Fried SJ, Satiani B, Zeeb P. J Trauma 1986; 26: 183–188

Treatment to Prevent Postnatal Loss of Brain Water Reduces the Risk of Intracranial Hemorrhage in the Beagle Puppy

We compared the risk of intracranial hemorrhage after a hypovolemic, hypotensive insult followed by rapid volume replacement in three groups of beagle puppies: one group less than 12 h old, a second, 72 h of age, and a third, 72 h of age, which had been treated from birth with ovine prolactin in the dose per kilogram which prevents postnatal brain water loss in rabbits. Intracerebral hemorrhage occurred in 14% of day 1 animals, 68% of untreated animals on day 3, and 15% of the group treated with prolactin. These data suggest that postnatal loss of brain water predisposes to intracerebral hemorrhage and that treatment to prevent this water loss can reduce the risk of intracerebral hemorrhage at 72 h of age.

Rapid volume replacement for hypovolemic shock: A comparison of techniques and equipment: Millikan JS, Cain TL, Hansbrough J. J Trauma 1984: 24:428–431

Rapid volume replacement for hypovolemic shock: A comparison of techniques and equipment: Millikan JS, Cain TL, Hansbrough J. J Trauma 1984: 24:428–431

HYPOVOLÆMIA IN STATUS ASTHMATICUS

A significant, though variable, hæmoconcentration was observed during eleven episodes of status asthmaticus in nine patients with bronchial asthma, aged 18-43. Mean blood-volume was 55.9 ml. per kg. as compared with 63.3 ml. per kg. in healthy persons matched for age, sex, and weight. Blood-volume was also diminished when compared with the patient's own values measured for the asthma-free interval, the hæmatocrit during the attack being increased by 7% and the serum-proteins by 0.6 g. per 100 ml. During or immediately after relief of the airway obstruction pulse-rate rose and bloodpressure fell accompanied by clinical signs of collapse in four patients. Central venous pressure was below 0 cm. water in this phase in all five patients for whom it was recorded. Rapid parenteral volume replacement in five patients led to immediate circulatory improvement. A possible relation of hypovolæmia with the unexplained death of asthmatic patients is suggested.

Massive Bleeding of Colonic Origin

Acute gastrointestinal bleeding remains a common cause of hospitalization despite advances in diagnosis and therapy. Patient morbidity and mortality in gastrointestinal hemorrhage frequently are related to the underlying illness rather than the bleeding itself.52 It is important that the patient is managed appropriately in the setting of an acute bleeding episode. Adequate treatment depends on assessing of hemodynamic stability accurately, determining the rate of active bleeding, and identifying the bleeding source. Hemodynamic stability is determined by measuring orthostatic blood pressure and the rate of resting tachycardia. Adequate intravenous access and rapid intravascular volume replacement are essential in correcting or avoiding further hemodynamic compromise. Fluid administration and red blood cell replacement as well as correction of any coagulopathy present with platelets or fresh-frozen plasma are the mainstay of immediate care. Large-volume hematemesis and hematochezia (bright red blood per rectum) are more obvious indicators of active bleeding, but the degree of bleeding often is less evident.103 Nasogastric aspiration may be helpful in patients without hematemesis, but it is limited by its lack of specificity and sensitivity. Once the aforementioned issues have been addressed, further assessment of the bleeding source can be determined endoscopically or radiographically. Acute upper gastrointestinal, small bowel, and lower gastrointestinal bleeding have various clinical presentations and therapies that need to be recognized.