Comparison of Normal Saline, Hypertonic Saline Albumin and Terlipressin plus Hypertonic Saline Albumin in an Infant Animal Model of Hypovolemic Shock

Abstract

IntroductionIn series of cases and animal models suffering hemorrhagic shock, the use of vasopressors has shown potential benefits regarding hemodynamics and tissue perfusion. Terlipressin is an analogue of vasopressin with a longer half-life that can be administered by bolus injection. We have previously observed that hypertonic albumin improves resuscitation following controlled hemorrhage in piglets. The aim of the present study was to analyze whether the treatment with the combination of terlipressin and hypertonic albumin can produce better hemodynamic and tissular perfusion parameters than normal saline or hypertonic albumin alone at early stages of hemorrhagic shock in an infant animal model.MethodsExperimental, randomized animal study including 39 2-to-3-month-old piglets. Thirty minutes after controlled 30 ml/kg bleed, pigs were randomized to receive either normal saline (NS) 30 ml/kg (n = 13), 5% albumin plus 3% hypertonic saline (AHS) 15 ml/kg (n = 13) or single bolus of terlipressin 15 μg/kg i.v. plus 5% albumin plus 3% hypertonic saline 15 ml/kg (TAHS) (n = 13) over 30 minutes. Global hemodynamic and tissular perfusion parameters were compared.ResultsAfter controlled bleed a significant decrease of blood pressure, cardiac index, central venous saturation, carotid and peripheral blood flow, brain saturation and an increase of heart rate, gastric PCO2 and lactate was observed. After treatment no significant differences in most hemodynamic (cardiac index, mean arterial pressure) and perfusion parameters (lactate, gastric PCO2, brain saturation, cutaneous blood flow) were observed between the three therapeutic groups. AHS and TAHS produced higher increase in stroke volume index and carotid blood flow than NS.ConclusionsIn this pediatric animal model of hypovolemic shock, albumin plus hypertonic saline with or without terlipressin achieved similar hemodynamics and perfusion parameters than twice the volume of NS. Addition of terlipressin did not produce better results than AHS.

Application of pulsed arterial resuscitation in a rabbit model of hemorrhagic shock

“…However, because of its complex nature and risk of adverse reactions such as vasospasm and limb ischemia, it is currently only used as a backup plan in cases of severe shock, acute blood loss, near-death state, and clinical death. [6,17,27] In this study, during the process of preparing the hemorrhagic shock model, the average blood loss of the experimental animals was 25 mL/kg, and MAP decreased to 50% of the baseline value and stabilized at approximately 50 mmHg. MAP, pulse pressure, urine output, and blood lactate levels showed significant changes, indicating that the model met the requirements and was accurate.…”

“…Hypoxemia has always been considered the root cause of complications in shock and the major cause of mortality in these rabbits. [13,15,17] Therefore, it is reasonable to believe that the application of pulsed arterial blood reinfusion may reduce early mortality in patients with hemorrhagic shock, while also having positive effects on the incidence of complications due to shock and late mortality. [13,28,29] In addition to rapidly increasing the effective circulating blood volume, arterial blood transfusion can pump the blood directly into the aorta, from where most of the blood is directly transported to various organs in need, particularly including the heart, brain, and kidneys; this process can rapidly improve the ischemic and hypoxic status of the body.…”

“…[4,17] After catheterization was completed and stabilized for 10 min, the blood pressure and heart rate were recorded, and blood samples were obtained as the baseline parameters. Next, blood was withdrawn at 2 mL/min from the common carotid artery through a 50-mL syringe.…”

Sodium Alginate as Treatment for Penetrating Abdominal Trauma- Feasibility Study.

“…In order to establish a valid trauma model, one must demonstrate change in several parameters that re ect the degree of organ damage and shock. Those parameters include hemodynamics, blood biochemical pro le, endocrine pro le and in our model also markers of hepatic tissue damage (23)(24)(25)(26). Also histopathologic samples from liver tissues in a setting of shock demonstrate certain changes such as central lobular necrosis (27).…”

Addition of terlipressin to initial volume resuscitation in a pediatric model of hemorrhagic shock improves hemodynamics and cerebral perfusion

“…In our study, the addition of the vasoconstrictor was associated with longer maintenance of the values obtained in response to the aggression. In another experimental porcine model, no variations were observed in SRVI attributable to the addition of TP, although it was given at a dose of 15 mcg/kg and compared to hypertonic saline [ 18 ].…”