Improved outcome with fluid restriction in treatment of uncontrolled hemorrhagic shock

Capone, A; Šafář, Peter; Stezoski, William; Tisherman, S; Ab, Peitzman

doi:10.1016/0300-9572(95)94130-2

Cited by 72 publications

(113 citation statements)

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“…The mortality rate (7.3%) was the same for both groups of patients. However, comparison of Injury Severity Scores 26 indicated that patients in the low group (scores, [16][17][18][19][20][21][22][23][24] were more severely injured (P = .02) than were patients in the conventional group (scores, 9-15). Thus, permissive hypotensive resuscitation may benefit restoration of blood circulation and cause a modest increase in blood pressure (reducing the risk of additional blood loss due to continued bleeding or rebleeding) with minimal fluid requirements.…”

Section: Studies Of Permissive Hypotension In Humansmentioning

confidence: 94%

“…20 A systematic meta-analysis of preclinical data (52 animal trials) 21 indicated an increased adjusted relative risk of death, from 0.69 to 1.80, when aggressive resuscitation was used in animals with less severe hemorrhage (ie, tail resection). In other trials, 16,17 attempts to increase MAP to 80 mm Hg with fluid resuscitation in animals with established hypovolemic shock were associated with decreased oxygen supply to the tissues, metabolic acidosis, and a poor outcome.…”

Section: Experimental Assessment Of Permissive Hypotension In Animalsmentioning

confidence: 99%

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Permissive Hypotension in Bleeding Trauma Patients: Helpful or Not and When?

Gourgiotis

Gemenetzis

Kocher

et al. 2013

Critical Care Nurse

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T rauma remains the leading cause of mortality among persons 1 to 44 years old in the United States 1 and accounts for almost 9% of total mortality worldwide. 2 In 2008 a total of 663000 injury-related deaths occurred in Europe (6.9% of total deaths). 2 Uncontrolled bleeding and exsanguination are the leading cause of preventable death after trauma 3 and require early detection of potential bleeding sources and prompt action to minimize blood loss, restore tissue perfusion, and achieve a stable hemodynamic status. Permissive Hypotension in CNE Continuing Nursing EducationCover Severity of hemorrhage and rate of bleeding are fundamental factors in the outcomes of trauma. Intravenous administration of fluid is the basic treatment to maintain blood pressure until bleeding is controlled. The main guideline, used almost worldwide, Advanced Trauma Life Support, established by the American College of Surgeons in 1976, calls for aggressive administration of intravenous fluids, primarily crystalloid solutions. Several other guidelines, such as Prehospital Trauma Life Support, Trauma Evaluation and Management, and Advanced Trauma Operative Management, are applied according to a patient's current condition. However, the ideal strategy remains unclear. With permissive hypotension, also known as hypotensive resuscitation, fluid administration is less aggressive. The available models of permissive hypotension are based on hypotheses in hypovolemic physiology and restricted clinical trials in animals. Before these models can be used in patients, randomized, controlled clinical trials are necessary. (Critical Care Nurse. 2013;33[6]:18-25)

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Section: Studies Of Permissive Hypotension In Humansmentioning

confidence: 94%

Section: Experimental Assessment Of Permissive Hypotension In Animalsmentioning

confidence: 99%

Permissive Hypotension in Bleeding Trauma Patients: Helpful or Not and When?

Gourgiotis

Gemenetzis

Kocher

et al. 2013

Critical Care Nurse

View full text Add to dashboard Cite

show abstract

“…Using the method created by Capone et al(1995), the model of rat with severe hemorrhagic shock was established. Under light anesthesia, the injury began (time=zero) with blood withdrawal through the carotid arterial cannula for four times (at a rate of 1 ml per 100 g per 5 min in the first two times, 0.5 ml per 100 g per 5 min in the later two times).…”

Section: Experimental Protocolmentioning

confidence: 99%

Hypertonic saline resuscitation maintains a more balanced profile of T-lymphocyte subpopulations in a rat model of hemorrhagic shock

Cai

et al. 2007

J. Zhejiang Univ. - Sci. B

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Abstract:Objective: To investigate the potential and early effect of hypertonic saline resuscitation on T-lymphocyte subpopulations in rats with hemorrhagic shock. Methods: A model of rat with severe hemorrhagic shock was established in 18 Sprague-Dawley (SD) rats. The rats were randomly divided into Sham group, HTS group (hypertonic saline resuscitation group) and NS group (normal saline resuscitation group). Each group contained 6 rats. The CD4 + and CD8 + subpopulations of T-lymphocytes in peripheral blood were detected respectively before shock and after resuscitation by double antibody labelling and flow cytometry. Results: In the early stage after hemorrhagic shock, fluid resuscitation and emergency treatment, the CD4 + lymphocytes of peripheral blood in HTS and NS groups markedly increased. Small volume resuscitation with HTS also induced peripheral CD8 + lymphocytes to a certain extent, whereas NS resuscitation showed no effect in this respect. Consequently, compared with Sham and HTS groups, CD4 + /CD8+ ratio of peripheral blood in NS group was obviously increased, and showed statistically differences. Conclusion: In this model of rat with severe hemorrhagic shock, small volume resuscitation with HTS is more effective than NS in reducing immunologic disorders and promoting a more balanced profile of T-lymphocyte subpopulations regulating network.

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“…Profound initial blood losses or conditions of prolonged transport to the operating room can overwhelm compensation and result in death. On the basis of the above-mentioned theories, some scholars advocate the concept of "controlled fluid resuscitation", which only administers moderate fluid infusion to prolong the compensatory time of patients with traumatic hemorrhagic shock before surgical hemostasis (Capone et al, 1995;Burris et al, 1999;Kim et al, 1997). Controlled fluid resuscitation means restoring some intravascular volume while taking into consideration hemostatic mechanisms, which allows prehospital treatment to work with compensatory mechanisms, balances the seemingly mutually exclusive processes of tissue perfusion and hemostasis.…”

Section: Discussionmentioning

confidence: 99%

“…The model of rat with severe hemorrhagic shock and active bleeding was established (Capone et al, 1995). Under light anesthesia, the injury began (time=0) with blood withdrawal through the carotid arterial cannula for four times (at a rate of 1 ml per 100 g per 5 min in the first two times, 0.5 ml per 100 g per 5 min in the late two times).…”

Section: Methodsmentioning

confidence: 99%

Effects of three fluid resuscitation methods on apoptosis of visceral organs in rats with hemorrhagic shock

Cai

et al. 2005

J. Zhejiang Univ. Sci.

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Lu et al. / J Zhejiang Univ SCI 2005 6B(9)Abstract: Objective: To observe the effects of three fluid resuscitation methods on apoptosis of visceral organs in rats with hemorrhagic shock. Methods: A model of rat with severe hemorrhagic shock and active bleeding was established in 32 SD (Sprague-Dawley) rats. The rats were randomly divided into control group, no fluid resuscitation group (NF group), controlled fluid resuscitation group (NS40 group) and rapid large scale fluid resuscitation group (NS80 group). Each group contained 8 rats.The curative effects were compared. At the same time, the apoptosis in liver, kidney, lung and small intestinal mucosa of survivors after hemorrhage and resuscitation was detected by light microscopy in HE (hematoxylin and eosin) stained tissue sections, flow cytometry and terminal deoxynucleotidyl transferase dUTP nick end labelling (TUNEL). Results: The survival rate of early fluid resuscitation (14/16) was markedly higher than that of NF group (3/8). There was some apoptosis in liver, kidney, lung and small intestinal mucosa of all survivors. Compared with NF and NS40 groups, the apoptosis of liver, kidney and small intestinal mucosa of NS80 group was obviously increased. Conclusions: Among three fluid resuscitation methods, controlled fluid resuscitation can obviously improve the early survival rate and the apoptosis of liver, kidney and small intestinal mucosa in rats with severe and uncontrolled hemorrhagic shock, and may benefit improvement of prognosis.

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Improved outcome with fluid restriction in treatment of uncontrolled hemorrhagic shock

Cited by 72 publications

References 0 publications

Permissive Hypotension in Bleeding Trauma Patients: Helpful or Not and When?

Permissive Hypotension in Bleeding Trauma Patients: Helpful or Not and When?

Hypertonic saline resuscitation maintains a more balanced profile of T-lymphocyte subpopulations in a rat model of hemorrhagic shock

Effects of three fluid resuscitation methods on apoptosis of visceral organs in rats with hemorrhagic shock

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