Early Colloid Replacement Therapy in a Near-Fatal Model of Hemorrhagic Shock

Abstract

Several controlled, experimental, hypotensive models of hemorrhagic shock have evaluated the effects of timing, rate, and types of fluid replacement. In a near-fatal experimental model we evaluated the hemodynamic and metabolic effects of two types of solutions for fluid resuscitation. In this study, 30 young Large-White pigs were randomly assigned to three groups: Group I (control, n= 10), not bled; Group II (hydroxyethyl starch, HES, n = 10), submitted to controlled hemorrhage to a mean arterial blood pressure (MAP) of 30 mmHg and blood lactate >10 mM/L, at which time resuscitation was initiated with 7 mL/kg of HES 130/0.4 6% followed by 33 mL/kg of lactated Ringer's solution (LR) and retransfusion; Group III (LR, n = 10), submitted to controlled hemorrhage to a MAP of 30 mmHg and blood lactate >10 mM/L, at which time resuscitation was initiated with 40 mL/kg of LR followed by retransfusion. The resuscitation with HES 130/0.4 proved to be superior to LR, expressed by hemodynamic and perfusion variables. Despite improvement in tissue perfusion, MAP did not totally return to baseline values. In conclusion, early colloid infusion resulted in prompt recovery of tissue perfusion when compared with infusion with an equal volume of crystalloid.

Comparison of two fluid solutions for resuscitation in a rabbit model of crush syndrome

“…We detected that the urinary NGAL level was increased in the two resuscitation groups, which might be associated with changes in the tubular epithelial cells and inflammation [21,22]. However, the urinary NGAL level was lower in the SAL/ HES group compared with the model group, indicating that the short-term combination resuscitation approach could [5,23]. In severe cases of CS, myoglobin-mediated oxidative damage induces up-regulation of the expression of endothelial adhesion molecules [24].…”

Protective Roles of Hydroxyethyl Starch 130/0.4 in Intestinal Inflammatory Response and Oxidative Stress After Hemorrhagic Shock and Resuscitation in Rats

“…In our study, both HES 130/0.4 and shed blood significantly decreased intestinal villous injuries and intestinal inflammatory response, compared with LR. Ferreira E et al [20] described early colloid infusion resulted in prompt recovery of tissue perfusion when compared with infusion with an equal volume of crystalloid. Marx G et al [21] described artificial colloids, but not RL maintains plasma volume and systemic oxygenation.…”

A fatal and metabolic experimental hemorrhagic shock in immature swine

“…The use of Accusport ® for the serial blood lactate determinations permitted monitoring anaerobiosis through lactic acidosis at intervals as short as five minutes. We were able to establish that for young swine the cutoff blood lactate of 10 mM/L can predict death if no treatment is instituted 17 . This model could be criticized because the sample is small, and it is possible that in a larger population we could prove to have untreated survivors that had reached blood lactate over 10 mM/L and this limitation may not be disregarded.…”

“…The lactimeter used in our experiments was Accusport ® which can read the lactate in a single drop of blood [16][17] . The use of Accusport ® for the serial blood lactate determinations permitted monitoring anaerobiosis through lactic acidosis at intervals as short as five minutes.…”