Norepinephrine Decreases Fluid Requirements and Blood Loss While Preserving Intestinal Villi Microcirculation during Fluid Resuscitation of Uncontrolled Hemorrhagic Shock in Mice

Harrois, Anatole; Baudry, Nathalie; Huet, Olivier; Kato, Hiromi; Dupic, Laurent; Lohez, Manuel; Ziol, Marianne; Vicaut, Éric; Duranteau, Jacques

doi:10.1097/aln.0000000000000639

Cited by 39 publications

(30 citation statements)

References 24 publications

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“…disproved the above argument. [27] In this study, 42 mice were subjected to uncontrolled hemorrhage and were then randomly allocated into various groups treated with no fluids, fluids alone, or fluids and norepinephrine infusion. The MAP was maintained between 50 and 60 mmHg, and the intestinal microcirculation was observed by intravital microscopy.…”

Section: Experimental Studiesmentioning

confidence: 99%

Vasopressors: Do they have any role in hemorrhagic shock?

Gupta

Garg

Ramachandran

2017

J Anaesthesiol Clin Pharmacol

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The priority in the management of patients with traumatic hemorrhagic shock is to control the bleeding with simultaneous volume resuscitation to maintain adequate tissue perfusion. Fluid replacement remains the mainstay of initial resuscitation in hemorrhagic shock. Traditionally, vasopressors are contraindicated in the early management of hemorrhagic shock due to their deleterious consequences, although vasopressors may have a role in resuscitation when vasoplegic shock ensues and blood pressure cannot be maintained by fluids alone. Use of vasopressors is not recommended according to the Advanced Trauma Life SupportR management principles. The role of vasopressors remains controversial with no clear guidelines on the timing, type, and dose of these drugs in hemorrhagic shock. Among vasopressors, norepinephrine and vasopressin have been used in the majority of the trials, although not many studies compare the effect of these two on long-term survival in trauma patients. This article reviews the pathophysiology of hemorrhagic shock, adverse effects of fluid resuscitation, and the various experimental and clinical studies on the use of vasopressors in the early phase of resuscitation in hemorrhagic shock.

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Section: Experimental Studiesmentioning

confidence: 99%

Vasopressors: Do they have any role in hemorrhagic shock?

Gupta

Garg

Ramachandran

2017

J Anaesthesiol Clin Pharmacol

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“…The vascular effects of recruiting a and b adrenoreceptors may prove to be beneficial in conditions of shock where excessive volume resuscitation may eventually lead to volume overload and increased morbidity. 76,77 Recent studies on mice demonstrated improved recovery from hemorrhagic shock when norepinephrine infusion was included in the treatment regimen 78 as it decreased the amount of fluid needed to maintain adequate hemodynamics. Moreover, that study demonstrated that the intestinal villi microcirculation was much better preserved when norepinephrine was included in the treatment.…”

Section: Effects Of Vasoactive Drugs Used During Gdhtmentioning

confidence: 99%

“…[86][87][88] Because such patients have significant impairment in vascular tone, their Vu remains large and Vs inadequate and the infused fluid ends up more in the Vu than Vs, and CO does not increase. Some data 56,64,[77][78][79][80] we presented and analyzed in the section on vasoactive drugs may justify the hypotheses that fluid therapy combined with small doses of venoconstricting drugs achieves a more beneficial distribution of infused fluid between the Vu and Vs and prevents fluid overload in the perioperative setting.…”

Section: Effects Of Vasoactive Drugs Used During Gdhtmentioning

confidence: 99%

The physiologic basis for goal-directed hemodynamic and fluid therapy: the pivotal role of the venous circulation

Gelman

Bigatello

2017

Can J Anesth/J Can Anesth

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“…Uncontrolled hemorrhage shock model in mice compared fluid requirements, blood loss, and intestinal microcirculation between fluid (i.e., 0.9 % saline) resuscitation with or without norepinephrine to target MAP at 50 and 60 mmHg [ 60 ]. The administration of norepinephrine significantly decreased fluid requirements by 60 % for MAP at 50 mmHg and 70 % for MAP at 60 mmHg compared to resuscitation only with fluid.…”

Section: Reviewmentioning

confidence: 99%

Context-sensitive fluid therapy in critical illness

Tatara

2016

j intensive care

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Microcirculatory alterations are frequently observed in critically ill patients undergoing major surgery and those who suffer from trauma or sepsis. Despite the need for adequate fluid administration to restore microcirculation, there is no consensus regarding optimal fluid therapy for these patients. The recent recognition of the importance of the endothelial glycocalyx layer in capillary fluid and solute exchange has largely changed our views on fluid therapy in critical illness. Given that disease status largely differs among critically ill patients, fluid therapy must not be considered generally, but rather tailored to the clinical condition of each patient. This review outlines the current understanding of context-sensitive volume expansion by fluid solutions and considers its clinical implications for critically ill patients. The modulation of capillary hydrostatic pressure through the appropriate use of vasopressors may increase the effectiveness of fluid infusion and thereby reduce detrimental effects resulting from excessive fluid administration.

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Norepinephrine Decreases Fluid Requirements and Blood Loss While Preserving Intestinal Villi Microcirculation during Fluid Resuscitation of Uncontrolled Hemorrhagic Shock in Mice

Abstract: During MAP-directed resuscitation of uncontrolled hemorrhagic shock, the administration of norepinephrine decreased blood loss and fluid requirements while preserving intestinal villi microcirculation.

Cited by 39 publications

References 24 publications

Vasopressors: Do they have any role in hemorrhagic shock?

Vasopressors: Do they have any role in hemorrhagic shock?

The physiologic basis for goal-directed hemodynamic and fluid therapy: the pivotal role of the venous circulation

Context-sensitive fluid therapy in critical illness

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