Five percent human albumin in lactated Ringer's solution for resuscitation from hemorrhagic shock: efficacy and cardiopulmonary consequences.
Using an ovine model of acute hemorrhagic shock, we evaluated the utility of 5% albumin in lactated Ringer's (5% ALR) solution as a resuscitation solution. After instrumentation and obtaining baseline values for BP, mean arterial pressure (MAP), pulmonary capillary wedge pressure (WP), CVP, cardiac output, extravascular lung water (EVLW), and blood gases (mixed venous and arterial), animals were rapidly exsanguinated to an MAP of 50 mm Hg. After 30 min at this pressure, measurements were repeated and 5% ALR was administered until two of three variables (WP, MAP, cardiac output) were restored to baseline values. The administration of 5% ALR was continued as needed to maintain baseline values of these variables. Sixty minutes later, data were again recorded. For induction of shock, 15.7 +/- 5.2 ml of blood/kg body weight was removed. Pulmonary artery pressure, WP, MAP, and cardiac output all significantly decreased with shock. After resuscitation, all values except MAP returned to baseline. The resuscitation volume of 5% ALR was 25.2 +/- 18.4 ml/kg. There were no changes in EVLW or intrapulmonary shunt. Oxygen delivery was significantly compromised during shock but returned to baseline after resuscitation. We conclude that in a model such as ours, 5% ALR can reverse the hemodynamic effects of acute hemorrhagic shock.
Layon
A J
AJ
Department of Anesthesiology, University of Florida College of Medicine, Gainesville.
Gallagher
T J
TJ
D000208:Acute Disease; D000818:Animals; D001794:Blood Pressure; D002245:Carbon Dioxide / Q000097:blood; D015633:Extravascular Lung Water / Q000502:physiology; D005260:Female; D005440:Fluid Therapy / Q000379:methods; D006439:Hemodynamics; D007552:Isotonic Solutions / Q000627:therapeutic use*; D008297:Male; D009997:Osmotic Pressure; D010100:Oxygen / Q000097:blood; D012151:Resuscitation; D000077325:Ringer's Lactate; D012709:Serum Albumin / Q000627:therapeutic use*; D012756:Sheep; D012771:Shock, Hemorrhagic / Q000097:blood / Q000503:physiopathology / Q000628:therapy*
D007552:Isotonic Solutions; D000077325:Ringer's Lactate; D012709:Serum Albumin; D002245:Carbon Dioxide; D010100:Oxygen