Hypertonic acetate dextran achieves high-flow-low-pressure resuscitation of hemorrhagic shock.
OBJECTIVE
For resuscitation of hemorrhagic hypovolemia, we compared the effectiveness of (1) isotonic lactated Ringer's solution (LRS), (2) 2400 mOsm of 7.5% NaCl:6% dextran 70 (HSD), and (3) 2400 mOsm of 7.9% sodium acetate:1.9% NaCl:6% dextran 70 (HAD).


METHODS
In six randomized, blinded experiments for each solution, conscious instrumented adult sheep were hemorrhaged by removing approximately 1.8 L (42 +/- 3 mL/kg) of blood, while maintaining the mean arterial pressure (MAP) at 50 mm Hg for 2 hours.


METHODS
Test solutions were infused as needed to restore the cardiac index to baseline.


RESULTS
Volume requirements with HAD (236 +/- 29 mL) and HSD (244 +/- 39 mL) were significantly less (p < 0.05) than LRS (3463 +/- 234 mL). Mean arterial pressure was normalized with HSD and LRS, but not with HAD, which resulted in MAPs of 20 to 25 mm Hg less than baseline resulting from a reduced peripheral resistance. Oxygen delivery, however, was significantly higher with HAD during the resuscitation period. Acid-base balance (pH) and oxygen consumption were normalized within 5 minutes of infusion only with HAD.


CONCLUSIONS
Small-volume infusion with HAD resulting in "high-flow-low-pressure" resuscitation may offer unique hemodynamic and metabolic advantages for the initial treatment of hemorrhage from trauma.
Nguyen
T T
TT
Department of Anesthesiology, University of Texas Medical Branch, Galveston 77555-0749, USA.
Zwischenberger
J B
JB
Watson
W C
WC
Traber
D L
DL
Prough
D S
DS
Herndon
D N
DN
Kramer
G C
GC
D000085:Acetates / Q000008:administration & dosage / Q000627:therapeutic use*; D019342:Acetic Acid; D000818:Animals; D001794:Blood Pressure; D002306:Cardiac Volume; D002712:Chlorides / Q000097:blood; D003911:Dextrans / Q000008:administration & dosage / Q000627:therapeutic use*; D006982:Hypertonic Solutions / Q000627:therapeutic use*; D007552:Isotonic Solutions / Q000627:therapeutic use; D010101:Oxygen Consumption; D012151:Resuscitation / Q000379:methods*; D000077331:Ringer's Solution; D012756:Sheep; D012771:Shock, Hemorrhagic / Q000503:physiopathology / Q000628:therapy*; D012965:Sodium Chloride / Q000008:administration & dosage / Q000627:therapeutic use
D000085:Acetates; D002712:Chlorides; D003911:Dextrans; D006982:Hypertonic Solutions; D007552:Isotonic Solutions; D012965:Sodium Chloride; D000077331:Ringer's Solution; D019342:Acetic Acid