title: Treatment of hemorrhagic shock with intraosseous or intravenous infusion of hypertonic saline dextran solution.
abstract: The efficacy of intravenous or intraosseous infusion of 250 ml of 7.5% NaCl and 6% dextran 60 (H/H) was compared with intravenous Ringer's lactate (RL) for the initial treatment of patients with hemorrhagic shock due to upper gastrointestinal bleeding. 49 patients were randomly assigned to receive either H/H (n = 26) or RL (n = 23). In the first 16 patients with H/H and in all RL patients, solutions were infused by the intravenous route, while the intraosseous route through sternal puncture was chosen for the last 10 H/H subjects. H/H patients were analyzed together since no differences were noticed between the routes of infusion. The H/H group also received 2.3 +/- 0.7 liters of intravenous crystalloid solutions in the first hour and 4.4 +/- 0.1 liters in the 24-hour period, while RL received 3.3 +/- 0.7 and 7.3 +/- 2.4 liters, respectively. Blood pressure (BP) increased during the first 15 min in the H/H group (from 61 +/- 17/30 +/- 12 to 85 +/- 30/48 +/- 14 mm Hg) and thereafter, while remaining unchanged in the RL group (from 75 +/- 18/40 +/- 12 to 75 +/- 17/40 +/- 14 mm Hg; p less than 0.05). The differences between groups were significant throughout 24 h. Urine output and improvement of the Glasgow Coma Score were also higher in H/H patients than in the control group (p less than 0.05). There were 5 deaths in RL group and 1 in the H/H group. Sternal of peripheral vein infusion of 250 ml of 7.5% NaCl/6% dextran 60 is an effective initial treatment of hemorrhagic shock.
authors.affiliation: Department of Internal Medicine, La Raza Medical Center, IMSS, Mexico City, Mexico.
authors.forename: A
authors.initials: A
authors.lastname: Chávez-Negrete
authors.forename: S
authors.initials: S
authors.lastname: Majluf Cruz
authors.forename: A
authors.initials: A
authors.lastname: Frati Munari
authors.forename: A
authors.initials: A
authors.lastname: Perches
authors.forename: R
authors.initials: R
authors.lastname: Argüero
mesh_terms: D001794:Blood Pressure; D003911:Dextrans / Q000008:administration & dosage* / Q000627:therapeutic use; D006801:Humans; D007262:Infusions, Intravenous; D007267:Injections; D012462:Saline Solution, Hypertonic / Q000008:administration & dosage* / Q000627:therapeutic use; D012771:Shock, Hemorrhagic / Q000097:blood / Q000503:physiopathology / Q000628:therapy*; D013249:Sternum; D013997:Time Factors
chemical_list: D003911:Dextrans; D012462:Saline Solution, Hypertonic