Goal-Directed Resuscitation Aiming Cardiac Index Masks Residual Hypovolemia: An Animal Experiment

Tánczos, Krisztián; Németh, Márton; Trásy, Domonkos; László, István; Palágyi, Péter; Szabó, Zsolt; Varga, Gabriella; Kaszaki, József

doi:10.1155/2015/160979

Cited by 6 publications

(6 citation statements)

References 43 publications

(40 reference statements)

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“…: MAP~60–65 mmHg) by most guidelines (4). Our current findings are in accord with that of published earlier in similar animal experiments, when bleeding caused almost identical changes in blood pressure, t bsl :112±23 to t 0 : 74±18 mmHg, p <0.05 [ 16 , 17 ]. Therefore, MAP may not only be an inappropriate resuscitation target but may also be an inadequate parameter to commence fluid resuscitation.…”

Section: Discussionsupporting

confidence: 94%

“…Cardiac output is a major determinant of DO 2 , and several studies encourage optimization of cardiac output during fluid therapy [ 26 , 27 ]. However, our previous series of animal experiments revealed that CO also has pitfalls as a therapeutic end-point [ 16 , 17 ]. Comparing CO-, vs. SV-guided resuscitation, the latter provided sufficient restoration of bleeding caused hemodynamic disturbances, while CO normalized because of persistent tachycardia, resulting in residual hypovolemia [ 17 ].…”

Section: Discussionmentioning

confidence: 99%

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Mean arterial pressure targeted fluid resuscitation may lead to fluid overload: A bleeding-resuscitation animal experiment

et al. 2018

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IntroductionFluid resuscitation is the cornerstone of treatment in hemorrhagic shock. Despite increasing doubts, several guidelines recommend to maintain mean arterial pressure (MAP) >65 mmHg as the most frequent indication of fluid therapy. Our aim was to investigate the effects of a MAP-guided management in a bleeding-resuscitation animal experiment.Materials and methodsAfter anesthesia and instrumentation (tbsl) animals were bled till the initial stroke volume index dropped by 50% (t0). Fluid replacement was performed in 4 equivalent steps (t1-4) with balanced crystalloid solution to reach the baseline values of MAP. Invasive hemodynamic measurements and blood gas analyses were performed after each step.ResultsMean arterial pressure dropped from tbsl to t0 (114±11 vs 76.9±16.9 mmHg, p<0.001) and returned to baseline by t4 (101.4±14.4 mmHg). From tbsl-t0 stroke volume index (SVI), cardiac index (CI) decreased (SVI: 40±8.6 vs 19.3±3.6 ml/m2, p<0.001; CI: 3.4±0.3 vs 1.9±0.3 l/min/m2, p<0.001), pulse pressure variation (PPV) increased (13.2±4.3 vs 22.1±4.3%, p<0.001). There was a decrease in oxygen delivery (464±45 vs 246±26.9 ml/min, p<0.001), central venous oxygen saturation (82.8±5.4 vs 53.6±12.1%, p<0.001) and increase in lactate levels (1.6±0.4 vs 3.5±1.6 mmol/l, p<0.005). SVI, CI and PPV returned to their initial values by t2. To normalize MAP fluid therapy had to be continued till t4, with the total infused volume of 4.5±0.8 l.ConclusionIn the current experiment bleeding led to hemorrhagic shock, while MAP remained higher than 65 mmHg. Furthermore, MAP was unable to indicate the normalization of SVI, CI and PPV that resulted in unnecessary fluid administration. Our data give further evidence that MAP may be an inappropriate parameter to follow during fluid resuscitation.

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Section: Discussionsupporting

confidence: 94%

Section: Discussionmentioning

confidence: 99%

Mean arterial pressure targeted fluid resuscitation may lead to fluid overload: A bleeding-resuscitation animal experiment

et al. 2018

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“…We applied a model which has been tested and reported in our previous experiments [ 22 , 23 ]. The study protocol is summarized in Fig.…”

Section: Methodsmentioning

confidence: 99%

Volume-replacement ratio for crystalloids and colloids during bleeding and resuscitation: an animal experiment

László

Demeter

Öveges

et al. 2017

ICMx

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BackgroundFluid resuscitation remains a cornerstone in the management of acute bleeding. According to Starling's “Three-compartment model”, four-times more crystalloids have the same volume effect as colloids. However, this volume-replacement ratio remains a controversial issue as it may be affected by the degradation of the endothelial glycocalyx layer, a situation often found in the critically ill. Our aim was to compare colloid and crystalloid based fluid resuscitation during an experimental stroke volume index (SVI) guided hemorrhage and resuscitation animal model.MethodsAnesthetized and mechanically ventilated pigs were randomized to receive a colloid (Voluven®,HES, n=15) or crystalloid (Ringerfundin®,RF, n=15) infusion. Animals were bled till baseline SVI (Tbsl) dropped by 50% (T0), followed by resuscitation until initial SVI was reached (T4) in four steps. Invasive hemodynamic measurements, blood gas analyses and laboratory tests were performed at each assessment points. Glycocalyx degradation markers (Syndecan-1/hematocrit ratio, Glypican/hematocrit ratio) were determined at Tbsl, T0 and T4.ResultsSimilar amounts of blood were shed in both groups (HES group: 506±159 mls blood, RF group: 470±127 mls blood). Hemodynamic changes followed the same pattern without significant difference between the groups. Animals received significantly less resuscitation fluid in the HES compared to the RF-group: 425 [320-665], vs 1390 [884-1585] mls, p <0.001. The volume replacement ratio was 0.92 [0.79-1.54] for HES; and 3.03 [2.00-4.23] for the RF-group (p <0.001). There was no significant difference between the groups in the glycocalyx degradation markers.ConclusionIn this moderate bleeding-resuscitation animal model the volume-replacement ratio for crystalloids and colloids followed similar patterns as predicted by Starling's principle, and the glycocalyx remained intact. This indicates that in acute bleeding events, such as trauma or during surgery, colloids may be beneficial as hemodynamic stability may be achieved more rapidly than with crystalloids.

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“…Hence, kidney-targeted approaches could improve patients’ outcomes. The current treatment approach is based on restoration of the macrohemodynamics such as blood pressure and heart rate during hemorrhagic shock [19, 20]. Fluid treatments are used as the first step for normalization deteriorated macrohemodynamics.…”

Section: Discussionmentioning

confidence: 99%

Fluid Resuscitation Aggravates the Cellular Injury in a Hemorrhagic Shock Model

2022

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Background: Resuscitation is the initial step for hemorrhagic shock. However, there is still controversy as to which fluid achieves the best results clinically and experimentally. Aim: It was aimed to investigate the effects of 0.9% NaCl (sodium chloride) and 6% HES (hydroxyethyl starch) on the kidney and blood environment. Methods: Twenty-four male Wistar rats were assigned as control, shock, and resuscitated (colloid: 6% HES and crystalloid: 0.9% NaCl) groups. Besides hemodynamics (mean arterial pressure and shock index) monitoring and kidney function evaluation, hemolysis, oxidative stress, inflammation, and glycocalyx degradation were evaluated in the plasma and kidney. Results: (1) Macrohemodynamics were successfully restored by both fluids. (2) Although 3 times more crystalloid volume was applied compared to the colloid resuscitation, similar hematocrit levels were found in both resuscitation strategies (32.8 ± 2.3 vs. 33.3 ± 1.0). (3) NaCl resuscitation led to increases in the hemolytic index, catalytic iron, and sialic acid compared to control, while HES administration increased the levels of malondialdehyde, ischemia-modified albumin, and sialic acid. (4) However, both fluid resuscitation strategies could inhibit inflammation and oxidative stress in the kidney and restore kidney function parameters. Conclusion: Although both NaCl and HES resuscitation showed protection of the kidney function against oxidative stress and inflammation, these fluids initiated the injury process.

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Goal-Directed Resuscitation Aiming Cardiac Index Masks Residual Hypovolemia: An Animal Experiment

Cited by 6 publications

References 43 publications

Mean arterial pressure targeted fluid resuscitation may lead to fluid overload: A bleeding-resuscitation animal experiment

Mean arterial pressure targeted fluid resuscitation may lead to fluid overload: A bleeding-resuscitation animal experiment

Volume-replacement ratio for crystalloids and colloids during bleeding and resuscitation: an animal experiment

Fluid Resuscitation Aggravates the Cellular Injury in a Hemorrhagic Shock Model

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