Treatment of uncontrolled hemorrhagic shock with hypertonic saline solution.
Hypertonic saline solution (HTS) treatment of uncontrolled hemorrhagic shock (UCHS) induced by incision of three major branches of the ileocolic artery, leading to free intra-abdominal bleeding, was studied in rats. The rats were divided into two groups. In group 1, the abdominal wall was closed immediately after induction of hemorrhage and the rats were divided into six subgroups--1a, five untreated; 1b, 14 treated with 5 milliliters per kilogram of sodium chloride 7.5 per cent (HTS) after five minutes; 1c, eight had HTS infused after 15 minutes; 1d, nine had HTS infused after 30 minutes; 1e, nine had HTS infused after 60 minutes, and 1f, nine had HTS infused after 120 minutes. In rats in group 2, the abdominal wall was kept open during HTS therapy and bleeding was estimated by the amount of sponges used to absorb shed blood. These rats were also divided into six subgroups--2a, five untreated; 2b, nine had HTS infused after five minutes; 2c, six had HTS infused after 15 minutes; 2d, six had HTS infused after 30 minutes; 2e, eight had HTS infused after 60 minutes, and 2f, six had HTS infused after 120 minutes. UCHS in group 1 was followed by a fall in the mean arterial pressure (MAP) from 99 to 46 torr (p less than 0.001) in five minutes and a gradual rise to 63 torr (p less than 0.01) after 30 minutes, with a survival rate of 80 per cent. HTS infusion five minutes after hemorrhage was followed by a further fall in MAP to 37 torr (p less than 0.01) after 30 minutes and a mortality rate of 85.7 per cent (p less than 0.01). HTS treatment after 15, 30, 60 and 120 minutes also led to a further fall in MAP and increased mortality. In group 2, the hemodynamic response to intra-abdominal vessel injury in untreated rats was similar to that of those in group 1 and the amount of sponges used to absorb shed blood was 2.4. After five, 60 and 120 minutes of HTS treatment, the hemodynamic response was similar to that in group 1. Five and one-half (p less than 0.01), 3.5 and 3.0 sponges, respectively, were used to absorb shed blood.(ABSTRACT TRUNCATED AT 400 WORDS)
Gross
D
D
Department of Surgery B, Hadassah University Hospital, Jerusalem.
Landau
E H
EH
Klin
B
B
Krausz
M M
MM
D000009:Abdominal Muscles / Q000293:injuries / Q000601:surgery; D000704:Analysis of Variance; D000818:Animals; D001794:Blood Pressure / Q000187:drug effects; D002302:Cardiac Output / Q000187:drug effects; D004195:Disease Models, Animal; D005069:Evaluation Studies as Topic; D005440:Fluid Therapy / Q000009:adverse effects; D006339:Heart Rate / Q000187:drug effects; D006470:Hemorrhage / Q000209:etiology; D008297:Male; D051381:Rats; D011919:Rats, Inbred Strains; D012462:Saline Solution, Hypertonic / Q000009:adverse effects / Q000627:therapeutic use*; D012771:Shock, Hemorrhagic / Q000401:mortality / Q000628:therapy*; D013997:Time Factors
D012462:Saline Solution, Hypertonic