Isochloremic hypertonic solutions for severe hemorrhage.
Two different hypertonic (2400 mOsm/L) isochloremic dextran solutions (sodium acetate, HAD; and sodium lactate, HLD; in 0.9% NaCl + 6% dextran 70) were compared with HSD (2400 mOsm/L NaCl + 6% dextran 70) as initial treatment for severe uninterrupted arterial bleeding. The substitution of dextran 70 for lactated Ringer's solution as the maintenance isotonic infusion fluid was also analyzed. Experiments were performed in pentobarbital-anesthetized dogs. A recently developed model, pressure-driven hemorrhage (PDH), which mimics uninterrupted arterial bleeding, was employed. It was found that (1) the substitution of dextran 70 for lactated Ringer's as isotonic fluid makes no difference in hemodynamic terms; (2) isochloremic hypertonic solutions are similar in their hemodynamic resuscitative effect, representing an improvement over hypertonic NaCl in terms of cardiac output, O2 delivery and O2 consumption; (3) HAD proved superior to HLD in terms of O2 consumption and correction of pH/base excess.
Rocha e Silva
M
M
Research Division, Instituto do Coração, Faculdade de Medicina, Universidade de São Paulo, Brasil.
Braga
G A
GA
Prist
R
R
Velasco
I T
IT
Grança
E S
ES
D000085:Acetates / Q000494:pharmacology / Q000627:therapeutic use*; D019342:Acetic Acid; D000818:Animals; D001784:Blood Gas Analysis; D001798:Blood Proteins / Q000032:analysis; D001810:Blood Volume; D002712:Chlorides / Q000097:blood; D003911:Dextrans / Q000494:pharmacology / Q000627:therapeutic use*; D004195:Disease Models, Animal; D004285:Dogs; D004338:Drug Combinations; D004353:Drug Evaluation, Preclinical; D006400:Hematocrit; D006439:Hemodynamics / Q000187:drug effects; D006470:Hemorrhage / Q000097:blood / Q000188:drug therapy* / Q000503:physiopathology; D006982:Hypertonic Solutions; D007262:Infusions, Intravenous; D007552:Isotonic Solutions / Q000494:pharmacology / Q000627:therapeutic use; D007773:Lactates / Q000494:pharmacology / Q000627:therapeutic use*; D019344:Lactic Acid; D008297:Male; D010101:Oxygen Consumption / Q000187:drug effects; D012151:Resuscitation / Q000379:methods*; D000077325:Ringer's Lactate; D012462:Saline Solution, Hypertonic / Q000494:pharmacology / Q000627:therapeutic use*; D012720:Severity of Illness Index; D012964:Sodium / Q000097:blood
D000085:Acetates; D001798:Blood Proteins; D002712:Chlorides; D003911:Dextrans; D004338:Drug Combinations; D006982:Hypertonic Solutions; D007552:Isotonic Solutions; D007773:Lactates; D000077325:Ringer's Lactate; D012462:Saline Solution, Hypertonic; D019344:Lactic Acid; D012964:Sodium; D019342:Acetic Acid