Hypertonic saline/dextran treatment for severe pressure-driven hemorrhage in dehydrated conscious swine.
Although dehydration impairs the response to a fixed volume hemorrhage, both 7.5% hypertonic saline/6% dextran 70 (HSD: 4 mL/kg) and standard Ringer's lactate (33 mL/kg) are effective resuscitation fluids. However, the efficacy of resuscitation during continuing hemorrhage remains in question. Using a conscious swine model of continuous pressure-driven hemorrhage, we evaluated the effects of dehydration and HSD resuscitation on survival time, hemorrhage volume, regional blood flows, and central hemodynamics. Three groups of pigs were compared: euhydrated control (EC), dehydrated control (48 h water deprived) (DC); and dehydrated and resuscitated with HSD (D + HSD). All pigs were subjected to an initial 37% blood volume hemorrhage for 60 min followed by a continuous hemorrhage proportional to the instantaneous mean arterial pressure. The D + HSD pigs were resuscitated at the end of the 37% blood volume hemorrhage. Dehydration reduced body weight (-6.5 +/- .3%) and increased hematocrit (8.9 +/- 1.8%), serum osmolality (11.6 +/- .9%), serum sodium (11.9 +/- .9%), and serum total protein (9.4 +/- 1.8%). Compared with the EC group, DC had a greater increase in heart rate and arterial base deficit in response to the pressure-driven hemorrhage and a reduced pH and survival time (159 vs. 107 min). In contrast to the DC group, D + HSD had increased mean arterial pressure, cardiac output, oxygen delivery, and regional blood flows to the gut (superior mesenteric artery), kidneys, liver (hepatic artery), and adrenals at 5 min after HSD resuscitation. The HSD did not increase blood loss but tended to prolong survival (+26 min; p = .1079). thus, dehydration compromises survival time (-33%) and the hemodynamic and metabolic responses to pressure-driven hemorrhage, while treatment with HSD improves the hemodynamic responses.
Alemayehu
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A
Department of Pathology, University of California, San Diego, La Jolla 92093, USA.
McKirnan
M D
MD
Mozingo
R D
RD
Gray
C G
CG
D000136:Acid-Base Equilibrium; D000818:Animals; D001784:Blood Gas Analysis; D003681:Dehydration / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology; D003911:Dextrans / Q000494:pharmacology*; D005260:Female; D006439:Hemodynamics / Q000187:drug effects; D006470:Hemorrhage / Q000150:complications / Q000188:drug therapy*; D009994:Osmolar Concentration; D010100:Oxygen / Q000378:metabolism; D011188:Potassium / Q000097:blood; D012039:Regional Blood Flow / Q000187:drug effects; D012151:Resuscitation / Q000401:mortality; D012462:Saline Solution, Hypertonic / Q000494:pharmacology*; D012964:Sodium / Q000097:blood; D013552:Swine; D013997:Time Factors
D003911:Dextrans; D012462:Saline Solution, Hypertonic; D012964:Sodium; D011188:Potassium; D010100:Oxygen