Resuscitation with 7.5% NaCl in 6% dextran-70 during hemorrhagic shock in swine

Maningas, Peter A

doi:10.1097/00003246-198712000-00009

Cited by 83 publications

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“…The use of 7.5% NaCl in shock produces vasodilatation and increased regional blood flow to coronary 32 , renal 6,33 , intestinal 14,19,34 and skeletal muscle 14 circulations. Effects of HS on myocardial contractility.…”

Section: -31mentioning

confidence: 99%

Small Volume Hypertonic Resuscitation of Circulatory Shock

Rocha-e-Silva

Figueiredo

2005

Clinics

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Small volume hypertonic resuscitation is a relatively new conceptual approach to shock therapy. It was originally based on the idea that a relatively large blood volume expansion could be obtained by administering a relatively small volume of fluid, taking advantage of osmosis. It was soon realized that the physiological vasodilator property of hypertonicity was a useful byproduct of small volume resuscitation in that it induced reperfusion of previously ischemic territories, even though such an effect encroached upon the malefic effects of the ischemia-reperfusion process. Subsequent research disclosed a number of previously unsuspected properties of hypertonic resuscitation, amongst them the correction of endothelial and red cell edema with significant consequences in terms of capillary blood flow. A whole set of actions of hypertonicity upon the immune system are being gradually uncovered, but the full implication of these observations with regard to the clinical scenario are still under study. Small volume resuscitation for shock is in current clinical use in some parts of the world, in spite of objections raised concerning its safety under conditions of uncontrolled bleeding. These objections stem mainly from experimental studies, but there are few signs that they may be of real clinical significance. This review attempts to cover the earlier and the more recent developments in this field.

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Section: -31mentioning

confidence: 99%

Small Volume Hypertonic Resuscitation of Circulatory Shock

Rocha-e-Silva

Figueiredo

2005

Clinics

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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%

“…Previous animal studies have similarly used infusion volumes higher than the standard 4 mL/kg. 4,5,32,33 In fact, the accepted 4 mL/kg infusion volume is arbitrary; to date, we know of no definitive study that has specifically evaluated the efficacy and potential untoward effects of various infusion volumes of hypertonic saline either with or without dextran.…”

Section: Limitations and Future Questionsmentioning

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%

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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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“…Average intravenous volumes infused during the prehospital period ranged from 500 mL to 1500 mL, clearly inadequate for the usual plasma replacement volume for severely hemorrhaged patients. Recent experimental animal studies have shown that the administration of hypertonic solutions improves hemodynamic parameters in hypovolemic shock, with a significant impact on survival [2][3][4][5][6][7][8] . Hypertonic solutions with varied salt concentrations have been tested, ranging from 1.5% NaCl to 24% NaCl (1000 mOsm/L to 8000 mOsm/L).…”

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confidence: 99%

Hypertonic/hyperoncotic solution in hypovolemic patients: experience in the emergency room

Younes

Birolini

2002

Rev. Hosp. Clin.

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Hypertonic solutions have been studied extensively in the treatment of hypovolemic shock, both in experimental and clinical models. Safety, efficacy, and long-term effects on animals and patients have been evaluated. The present article reviews indications, safety, mortality rates, and outcome in patients with hemorrhagic hypovolemic shock who were treated after admission with a hypertonic/hyperoncotic solution under strict observation in the emergency room.

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Resuscitation with 7.5% NaCl in 6% dextran-70 during hemorrhagic shock in swine

Cited by 83 publications

References 0 publications

Small Volume Hypertonic Resuscitation of Circulatory Shock

Small Volume Hypertonic Resuscitation of Circulatory Shock

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

Hypertonic/hyperoncotic solution in hypovolemic patients: experience in the emergency room

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