A comparison of several hypertonic solutions for resuscitation of bled sheep

Smith, G. J.; Kramer, George C.; Perron, P. R.; Nakayama, Shin; Gunther, Robert A.; Holcroft, James W.

doi:10.1016/0022-4804(85)90120-9

Cited by 214 publications

(80 citation statements)

References 12 publications

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“…Several mechanisms concerning the beneficial effects of HSS administration have been proposed; one is the expansion of circulating blood volume [2,3,9,12,18]. HSS draws water from interstitial or intracellular fluid compartments, increasing plasma volume, and consequently improves the perfusion of peripheral tissues.…”

Section: Discussionmentioning

confidence: 99%

“…The left jugular vein catheter was used for venous blood Hypertonic saline solution (HSS) has been used clinically for the treatment of severe blood loss in human being as early as 1919 [14]. The intravenous (iv) administration of a small volume (3-5 ml/kg) of 7.2%-HSS (2,400 mOsmol/ kg·H 2 O) has been successfully used to resuscitate sheep [18], horse [1,2], dogs [8,13,17,22], cats [10], calves [3][4][5][6]19] and cows [20,21] with experimentally induced hemorrhage, endotoxic or septic shock.…”

Section: Methodsmentioning

confidence: 99%

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Effect of a 7.2% Hypertonic Saline Solution Infusion on Arterial Blood Pressure, Serum Sodium Concentration and Osmotic Pressure in Normovolemic Heifers.

1998

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ABSTRACT. The effects of an intravenous (iv) infusion of a small volume (5 ml/kg) or large volume (15 ml/kg) of hypertonic saline solution (HSS; 7.2%, 2,400 mOsmol/kg·H 2 O) and those of an iv infusion of 5 ml/kg isotonic saline solution (ISS; 300 mOsmol/kg·H 2 O) on plasma volume, arterial blood pressure, serum sodium concentrations and osmotic pressure were investigated in conscious heifers. Nine heifers (3 heifers/group) were monitored for 120 min after the initiation of fluid replacement. The relative plasma volume (rPV) in the 5 ml/kg HSS and 15 ml/kg HSS progressively increased to 137.7 ± 2.4% at t=5 min and 145.2 ± 5.4% at t=15 min, respectively. The expanding plasma volume in the 5 ml/kg HSS group remained at an up to 10% higher level until 120 min, but not in the 15 ml/kg HSS group. The 5 ml/kg HSS infusion induced transit high-osmotic (305.3 ± 4.0 mOsmol/kg·H 2 O) and sodium levels (155.7 ± 3.5 mM/l) at t=5 min. However, the 15 ml/kg HSS infusion induced constant high-osmotic level (321.7-336.7 mOsmol/kg·H 2 O) and hypernatremia (162.8-170.0 mM/l) from t=10 min to the rest of the experiment period. In the ISS and 5 ml/kg HSS groups, no changes in PaO 2 were observed. The 15 ml/kg HSS infusion induced a significant decrease in the partial pressure of oxygen at the t=30 min compared to the t=0 min values. On the basis of these findings, a small volume (5 ml/kg) HSS infusion can be rapidly and safely administered to cattle for expanding the plasma volume without inducing hypernatremia. A 5 ml/kg HSS infusion is thus recommended for the initial field resuscitation of cattle. -KEY WORDS: heifer, hypernatremia, hypertonic saline solution, plasma volume, serum osmotic pressure.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Effect of a 7.2% Hypertonic Saline Solution Infusion on Arterial Blood Pressure, Serum Sodium Concentration and Osmotic Pressure in Normovolemic Heifers.

1998

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“…The addition of a colloid, such as dextran 70, to hypertonic saline has been demonstrated to transiently partition the recruited fluid in the plasma space and therefore prolong the theoretically beneficial hemodynamic effects of the hypertonic solution; the latter effect is secondary to the increase in osmotic pressure that results from colloid infusion. 3,[34][35][36][37] Several laboratory studies have compared the abilities of HTS and dextran, both alone and in combination, to expand intravascular volume and improve hemodynamics following varying periods of controlled hemorrhagic hypotension. The data consistently demonstrate improved outcome with infusion of 7.5% NaCl/6% dextran 70 as compared with either 7.5% NaCl or 6% dextran 70.…”

Section: Limitations and Future Questionsmentioning

confidence: 99%

“…The data consistently demonstrate improved outcome with infusion of 7.5% NaCl/6% dextran 70 as compared with either 7.5% NaCl or 6% dextran 70. 3,4,34,37 Maningas et al compared resuscitation with 11.5 mL/kg of HSD with that of an equal volume of HTS, 6% dextran 70 (DEX), and NS. 4 In this experiment swine were bled 45 mL/kg in a controlled fashion over 15 minutes, resuscitated, and then observed for 96 hours.…”

Section: Limitations and Future Questionsmentioning

confidence: 99%

Resuscitation of Severe Uncontrolled Hemorrhage 7.5% Sodium Chloride/6% Dextran 70 vs 0.9% Sodium Chloride

Stern¹,

Jwayyed²,

Dronen³

et al. 2000

Academic Emergency Medicine

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Abstract.Objectives: Resuscitation studies of hypertonic saline using controlled and uncontrolled hemorrhage models yield conflicting results with regard to efficacy. These disparate results reflect the use of models and resuscitation regimens that are not comparable between studies. This study evaluated the effects of comparable and clinically relevant resuscitation regimens of 7.5% sodium chloride/6% dextran 70 (HSD) and 0.9% sodium chloride (NS) in a near-fatal uncontrolled hemorrhage model. Methods: Thirty-six swine (14.2 to 21.4 kg) with 4-mm aortic tears were bled to a pulse pressure of 5 mm Hg (40-45 mL/kg). The animals were resuscitated with either NS or HSD administered in volumes that provided equivalent sodium loads at similar rates. Group II (n = 12) was resuscitated with 80 mL/kg of NS at a rate of 4 mL/kg/min. Group III (n = 12) received 9.6 mL/ kg of HSD at a rate of 0.48 mL/kg/min. In both groups, crystalloid resuscitation was followed by shed blood infusion (30 mL/kg) at a rate of 2 mL/kg/min. Group I (controls; n = 12) were not resuscitated. Results: One-hour mortality was significantly greater in group I (92%) as compared with group II (33%) and group III (33%) (Fisher's exact test; p = 0.004). Intraperitoneal hemorrhage was significantly greater in group II (34 Ϯ 20 mL/kg) and group III (31 Ϯ 13 mL/ kg) as compared with group I (5 Ϯ 2 mL/kg) (ANOVA; p < 0.05). There was no significant difference in hemodynamic parameters between groups II and III. Conclusion: In this model of severe uncontrolled hemorrhage, resuscitation with HSD or NS, administered in volumes that provided equivalent sodium loads at similar rates, had similar effects on mortality, hemodynamic parameters, and hemorrhage from the injury site. Key words: uncontrolled hemorrhage; shock; resuscitation; hypertonic saline; hemorrhage models; pig. ACADEMIC EMERGENCY MEDICINE 2000; 7:847-856 S TANDARD management of acute life-threatening hemorrhagic hypotension includes attempts to restore blood pressure (BP) to normal or near-normal levels through rapid administration of large volumes of isotonic crystalloid. 1 An alternative resuscitation agent that has shown considerable promise is 7.5% sodium chloride (HTS), used alone or in combination with 6% dextran 70 (HSD). Several animal studies of acute hemorrhagic hypotension have demonstrated that smallvolume infusions of HTS and HSD are more effec- tive in increasing BP, increasing cardiac output, and providing volume expansion as compared with conventional isotonic crystalloids. 2-10 Based on these studies, several authors have advocated the out-of-hospital administration of hypertonic crystalloids for acute hemorrhagic shock. However, not all of the hypertonic saline studies have demonstrated improvement in outcome from resuscitation of acute hemorrhage. More recent studies demonstrate that hypertonic saline resuscitation increases hemorrhage volume and mortality, presumably the result of a rapid rise in BP. [11][12][13][14][15] The authors of the latter studies therefore caution ...

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“…Spinal anesthesia causes more rapid changes in hemodynamics than does extradural anesthesia. The effect of hypertonic saline is rapid and short-lasting (10). Therefore, it could be even more suitable for the initial fluid administration before spinal anesthesia than before extradural anesthesia.…”

mentioning

confidence: 99%

The Comparison of Hypertonic Saline (7.5%) and Normal Saline (0.9%) for Initial Fluid Administration Before Spinal Anesthesia

Järvelä

Honkonen²,

Järvelä³

et al. 2000

Anesthesia & Analgesia

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Hypertonic saline can be used for initial fluid administration before spinal anesthesia. It is effective in smallvolume fluid resuscitation. This randomized doubleblinded study compared the effects of 7.5% hypertonic saline (HS) and 0.9% normal saline (NS) in doses containing 2 mmol/kg of sodium in 40 ASA physical status I-II patients undergoing arthroscopy or other lower limb surgery under spinal anesthesia. We infused 1.6 mL/kg of HS or 13 mL/kg of NS for initial fluid administration before spinal anesthesia induced with a 10-mg dose of 0.5% hyperbaric bupivacaine. Etilefrine was administered to maintain mean arterial pressure at Ն80% of its control value. Systolic and diastolic blood pressure, heart rate, and cardiac index did not differ between the groups, and the amount of etilefrine administered was similar in the treatment groups. In all our patients, the plasma sodium concentrations were within the normal range after surgery and serum osmolality was within the normal range after spinal anesthesia. The time and the volume of the first micturition were similar in both groups, despite the much smaller amount of infused free water in the HS group. We conclude that 7.5% HS was as good as NS for the initial fluid administration before spinal anesthesia when the amount of sodium was kept unchanged.

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A comparison of several hypertonic solutions for resuscitation of bled sheep

Cited by 214 publications

References 12 publications

Effect of a 7.2% Hypertonic Saline Solution Infusion on Arterial Blood Pressure, Serum Sodium Concentration and Osmotic Pressure in Normovolemic Heifers.

Effect of a 7.2% Hypertonic Saline Solution Infusion on Arterial Blood Pressure, Serum Sodium Concentration and Osmotic Pressure in Normovolemic Heifers.

Resuscitation of Severe Uncontrolled Hemorrhage 7.5% Sodium Chloride/6% Dextran 70 vs 0.9% Sodium Chloride

The Comparison of Hypertonic Saline (7.5%) and Normal Saline (0.9%) for Initial Fluid Administration Before Spinal Anesthesia

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