Hyperosmotic NaCl and severe hemorrhagic shock

Velasco, I. T.; Pontieri, Vera; Silva, M. Rocha e; Lopes, Oswaldo Ubrı́aco

doi:10.1152/ajpheart.1980.239.5.h664

Cited by 200 publications

(216 citation statements)

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“…Estes dados confirmam os obtidos por Velasco et al (1980) e Kramer (1986), que descreveram que a administração de solução NaCl 7,5% aumentou a PAM, o DC e corrigiu os distúrbios metabólicos, por período superior a seis horas.…”

Section: Resultsunclassified

“…A constatação de que o emprego de pequeno volume de solução hipertônica de cloreto de sódio (NaCl 7,5%) promovia restabelecimento imediato e definitivo dos parâmetros hemodinâmicos de cães submetidos a choque hemorrágico grave fez surgir um novo conceito na terapia do choque. A administração de solução hipertônica aumentou a pressão arterial média (PAM), o débito cardíaco (DC) e corrigiu os distúrbios metabólicos, por período superior a seis horas (Velasco et al,1980;Kramer, 1986). A taxa de sobrevida foi de 100% nos animais tratados com NaCl 7,5% enquanto os animais que receberam somente NaCl 0,9% morreram nas primeiras 6,5 horas após a indução da hipovolemia.…”

Section: Introductionunclassified

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Efeitos cardiovasculares da anestesia dissociativa na reposição volêmica com colóide e solução hipertônica em cães: avaliação biotelemétrica

Oleskovicz

Moreno

Guirro

et al. 2009

Arq. Bras. Med. Vet. Zootec.

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RESUMOAvaliaram-se os efeitos cardiovasculares por um período de 24 horas, após a administração de solução salina hipertônica (NaCl) 7,5% ou em associação ao hidroxietilamido 130/0,4 (HES), em cães com hipovolemia induzida e tratados com cetamina levógira ou racêmica. Após a indução da hipovolemia, administrou-se NaCl 7,5% (4mL/kg) no grupo hipertônica levógira (GHL) e no grupo hipertônica racêmica (GHR) ou HES 130/0,4 na mesma proporção de sangue retirado, associado a NaCl 7,5% (4mL/kg) no grupo hipertônica colóide levógira (GHCL) e no grupo hipertônica colóide racêmica (GHCR). Após 30 minutos, administrou-se por via intravenosa, cetamina levógira (CL; 5mg/kg) no GHL e GHCL ou cetamina racêmica (CR; 10mg/kg) no GHR e GHCR. A frequência cardíaca (FC) e a pressão arterial sistólica (PAS) foram menores após a hipovolemia e após a CR. A pressão arterial média (PAM) e a pressão arterial diastólica (PAD) foram menores após a hipovolemia e após a administração de CL e CR. Não foram observadas diferenças significativas entre os grupos em relação à FC, PAS, PAM e PAD durante o período de mensuração por biotelemetria desde T210 até T1440. A administração de HES associado ao NaCl 7,5% propiciou restabelecimento imediato da PAM, a administração de NaCl 7,5% não restaurou a PAM em pacientes hipovolêmicos, a administração de CR ou CL produziu efeitos semelhantes e todos os tratamentos mantiveram estáveis as pressões arteriais e a FC por um período de até 24 horas.Palavras-chave: cão, solução hipertônica, hidroxietilamido, hipovolemia, biotelemtria HSG and HCSG groups, ABSTRACT The cardiovascular effects were evaluated for a 24-hour period, after the administration of hypertonic solution (NaCl 7.5%) or in association with hidroxyethyl starch 130/0.4 (HES) in dogs under induced experimental hypovolemia and treated with racemic ketamine (RK) or S(+) ketamine (SK). After the hypovolemia induction, administration of NaCl 7.5% (4mL.kg -1 ) was performed in two groups named hypertonic S(+) (HSG) and hypertonic racemic (HRG), or NaCl 7.5% (4mL.kg -1 ) in association with HES, in the same ratio of removed blood, in two groups named hypertonic colloid S(+) (HCSG) and hypertonic colloid racemic (HCRG). After 30 minutes, SK (5mg.kg -1 ) was administered by intravenous injection in

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Section: Resultsunclassified

Section: Introductionunclassified

Efeitos cardiovasculares da anestesia dissociativa na reposição volêmica com colóide e solução hipertônica em cães: avaliação biotelemétrica

Oleskovicz

Moreno

Guirro

et al. 2009

Arq. Bras. Med. Vet. Zootec.

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“…In the controlled hemorrhage studies, investigators commonly administered equal volumes of hypertonic and isotonic saline. [2][3][4][5][6][7] The hypertonic saline-treated animals therefore received significantly greater sodium loads as compared with the isotonic saline-treated animals. The relevance of this becomes apparent when one considers the mechanisms by which HTS is thought to restore hemodynamics: 1) by inducing an osmotic fluid shift from the intracellular to the extracellular space, resulting in intravascular expansion, 2) by decreasing total peripheral resistance, and 3) by increasing myocardial contractility.…”

Section: Discussionmentioning

confidence: 99%

“…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][3][4][5][6][7][8][9][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.…”

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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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“…The use of small-volume hypertonic solutions for ressuscitation has proved to be an interesting alternative in experimental models of hemorrhagic shock 6 . Pioneer studies conducted in Brazil in the eighties have revealed that the infusion of small volumes of 7.5% NaCl solution produces rapid restoration of hemodynamic parameters and thus less demand for blood transfusions 7 . Subsequently, it was demonstrated that the addition of a hypertonic solution could increase and prolong the beneficial effects of a hyperoncotic solution 8 .…”

Section: Introductionmentioning

confidence: 99%

Hemodynamic effects of volume replacement with saline solution and hypertonic hydroxyethyl starch in dogs

et al. 2009

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Purpose: To investigate hemodynamic response to volume replacement with saline solution and hypertonic hydroxyethyl starch in hypovolemic dogs. Methods: Forty dogs under general anesthesia and hemodynamic monitoring, following measurements at baseline, were bled 20 ml.Kg -1 and parameters were measured again after 10 minutes. The animals were randomly divided in two groups and volume replacement was performed with saline solution twice the volume removed or 4 ml.Kg -1 of hypertonic hydroxyethyl starch. Hemodynamic data were again measured after 5, 15, 30, 45 and 60 minutes. Results: With both solutions values returned to satisfactory hemodynamic levels. With saline solution, there was a greater amplitude in variations that tended to decrease progressively. With hypertonic hydroxyethyl starch, the parameters studied returned more rapidly to levels similar to those at baseline and varied less. Conclusion: Both solutions proved to be efficient at replacing volume in the short period studied, although hypertonic hydroxyethyl starch produced more stable results. Key words: Hemodynamics. Hypovolemia. Hetastarch. Saline Solution, Hypertonic. Dogs. RESUMOObjetivo: Avaliar em cães hipovolêmicos as respostas hemodinâmicas da reposição volêmica com solução salina e hidroxi-etil amido hipertônico. Métodos: Quarenta cães sob anestesia geral e monitorização hemodinâmica, após medidas em repouso foram sangrados 20 ml.Kg -1 e tiveram os parâmetros novamente medidos após 10 minutos. Os animais foram aleatoriamente divididos em dois grupos nos quais foi realizada reposição volêmica com solução fisiológica duas vezes o volume retirado ou 4 ml.Kg -1 de hidroxi-etil amido hipertônico e os dados hemodinâmicos medidos novamente após 5, 15, 30, 45 e 60 minutos. Resultados: A reposição volêmica com as duas soluções fez os valores retornarem a níveis hemodinâmicos satisfatórios, a amplitude das variações com solução fisiológica foi maior, mas tendeu a diminuir progressivamente, com o hidroxi-etil amido hipertônico os parâmetros estudados retornaram a semelhantes ao repouso mais rapidamente e variaram menos. Conclusão: Ambas soluções se mostraram eficientes na reposição volêmica, o hidroxi-etil amido hipertônico proporcionou resultados mais estáveis.

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Hyperosmotic NaCl and severe hemorrhagic shock

Cited by 200 publications

References 0 publications

Efeitos cardiovasculares da anestesia dissociativa na reposição volêmica com colóide e solução hipertônica em cães: avaliação biotelemétrica

Efeitos cardiovasculares da anestesia dissociativa na reposição volêmica com colóide e solução hipertônica em cães: avaliação biotelemétrica

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

Hemodynamic effects of volume replacement with saline solution and hypertonic hydroxyethyl starch in dogs

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