title: Initial management of severe hemorrhage with an oxygen-carrying hypertonic saline solution.
abstract: We tested the hypothesis that the combination of polymerized bovine hemoglobin (PBHg) with hypertonic saline may be beneficial for the initial management of hemorrhagic shock in 22 mongrel dogs (15 +/- 1 kg) bled to a mean arterial pressure (MAP) of 40 mm Hg in 5 min and maintained at this level for 45 min (shed blood volume approximately 50 ml/kg). Animals were treated with a 4 ml/kg bolus over 4 min of one of the following fluids: whole blood, 7.5% NaCl (HS), 13 g/dl of PBHg, or 7.5% NaCl combined with polymerized bovine hemoglobin (HS-PBHg). No additional intervention was performed, and the animals were followed for 60 min after treatment. PBHg and HS-PBHg produced a sustained, significant increase in MAP. Cardiac output was transiently increased only after HS and HS-PBHg. A partial increase in superior mesenteric artery blood flow was observed, particularly after HS-PBHg. We concluded that small volumes of PBHg alone restore MAP, but not blood flow. The combination of PBHg with hypertonic saline provides improvements in cardiac output and mesenteric blood flow, suggesting a potential benefit for the initial management of major blood loss.
authors.affiliation: Department of Cardiopneumology, Heart Institute (InCor), University of São Paulo Medical School, Brazil. expluiz@incor.usp.br
authors.forename: L F
authors.initials: LF
authors.lastname: de Figueiredo
authors.forename: R J
authors.initials: RJ
authors.lastname: Cruz
authors.forename: A C
authors.initials: AC
authors.lastname: Neto
authors.forename: M M
authors.initials: MM
authors.lastname: Yada-Langui
authors.forename: M R
authors.initials: MR
authors.lastname: e Silva
mesh_terms: D000818:Animals; D001810:Blood Volume; D004285:Dogs; D004338:Drug Combinations; D006439:Hemodynamics; D006454:Hemoglobins / Q000627:therapeutic use*; D008297:Male; D010952:Plasma Substitutes / Q000627:therapeutic use*; D011108:Polymers / Q000627:therapeutic use*; D012151:Resuscitation / Q000379:methods; D012462:Saline Solution, Hypertonic / Q000627:therapeutic use*; D012771:Shock, Hemorrhagic / Q000503:physiopathology / Q000628:therapy*
chemical_list: D004338:Drug Combinations; D006454:Hemoglobins; D010952:Plasma Substitutes; D011108:Polymers; D012462:Saline Solution, Hypertonic; C080663:polymerized bovine hemoglobin