Effect of blood transfusion, dopamine, or normal saline on neurogenic shock secondary to acutely raised intracranial pressure.
An experimental model to simulate acutely raised intracranial pressure due to a rapidly expanding intracranial space-occupying lesion was used to produce neurogenic shock. Forty-one rats in neurogenic shock (defined as a mean systemic arterial pressure (SAP) of less than 60 mm Hg) were subjected to various treatments to increase the mean SAP to a level of more than 80 mm Hg. The control group with neurogenic shock received no treatment, and the six treatment groups received infusions of: whole blood, packed cells, plasma, normal saline, dopamine, or a combination of dopamine and saline. Detrimental effects were observed after transfusion of packed cells or whole blood, which caused further deterioration of mean SAP. Although dopamine or the combination of dopamine and saline were both effective (p = 0.0001) for reversing hypotension, the combination was the most effective. If this rat paradigm correlates with human disease, these results indicate that, in the absence of hypovolemia, neurogenic shock due to acute intracranial hypertension should be treated with a combined transfusion of dopamine and normal saline, but not blood since the latter could have a detrimental effect.
Rahimifar
M
M
Division of Neurosurgery, Toronto Western Hospital, Ontario, Canada.
Tator
C H
CH
Shanlin
R J
RJ
Sole
M J
MJ
D000818:Animals; D001803:Blood Transfusion; D004298:Dopamine / Q000008:administration & dosage*; D008297:Male; D011559:Pseudotumor Cerebri / Q000150:complications; D051381:Rats; D011919:Rats, Inbred Strains; D012769:Shock / Q000209:etiology / Q000628:therapy*; D012965:Sodium Chloride / Q000008:administration & dosage*
D012965:Sodium Chloride; D004298:Dopamine