title: Vasopressin, but not fluid resuscitation, enhances survival in a liver trauma model with uncontrolled and otherwise lethal hemorrhagic shock in pigs.
abstract: BACKGROUND
  The authors compared the effects of vasopressin fluid resuscitation on survival in a liver trauma model with uncontrolled and otherwise lethal hemorrhagic shock in pigs.
  
  
  METHODS
  A midline laparotomy was performed on 23 domestic pigs, followed by an incision, and subsequent finger fraction across the right medial liver lobe. During hemorrhagic shock, animals were randomly assigned to receive either 0.4 U/kg vasopressin (n = 9), or fluid resuscitation (n = 7), or saline placebo (n = 7), respectively. A continuous infusion of 0.08 U x kg(-1) x min(-1) vasopressin in the vasopressin group, or normal saline was subsequently administered in the fluid resuscitation and saline placebo group, respectively. After 30 min of experimental therapy, bleeding was controlled by surgical intervention, and blood transfusion and rapid fluid infusion were subsequently performed.
  
  
  RESULTS
  Maximum mean arterial blood pressure during experimental therapy in the vasopressin-treated animals was significantly higher than in the fluid resuscitation and saline placebo groups (mean +/- SD, 72 +/- 26 vs 38 +/- 16 vs 11 +/- 7 mmHg, respectively; P< 0.05). Subsequently, mean arterial blood pressure remained at approximately 40 mmHg in all vasopressin-treated animals, whereas mean arterial blood pressure in all fluid resuscitation and saline placebo pigs was close to aortic hydrostatic pressure (approximately 15 mmHg) within approximately 20 min of experimental therapy initiation. Total blood loss was significantly higher in the fluid resuscitation pigs compared with vasopressin or saline placebo after 10 min of experimental therapy (65 +/- 6 vs 42 +/- 4 vs 43 +/- 6 ml/kg, respectively; P< 0.05). Seven of seven fluid resuscitation, and seven of seven saline placebo pigs died within approximately 20 min of experimental therapy, while 8 of 9 vasopressin animals survived more than 7 days (P < 0.05).
  
  
  CONCLUSIONS
  Vasopressin, but not fluid resuscitation or saline placebo, ensured survival with full recovery in this liver trauma model with uncontrolled and otherwise lethal hemorrhagic shock in pigs.
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, Leopold-Franzens-University, Innsbruck, Austria. karl-heinz.stadlbauer@uibk.ac.at
authors.forename: Karl H
authors.initials: KH
authors.lastname: Stadlbauer
authors.forename: Horst G
authors.initials: HG
authors.lastname: Wagner-Berger
authors.forename: Claus
authors.initials: C
authors.lastname: Raedler
authors.forename: Wolfgang G
authors.initials: WG
authors.lastname: Voelckel
authors.forename: Volker
authors.initials: V
authors.lastname: Wenzel
authors.forename: Anette C
authors.initials: AC
authors.lastname: Krismer
authors.forename: Guenter
authors.initials: G
authors.lastname: Klima
authors.forename: Klaus
authors.initials: K
authors.lastname: Rheinberger
authors.forename: Walter
authors.initials: W
authors.lastname: Nussbaumer
authors.forename: Daniel
authors.initials: D
authors.lastname: Pressmar
authors.forename: Karl H
authors.initials: KH
authors.lastname: Lindner
authors.forename: Alfred
authors.initials: A
authors.lastname: Königsrainer
mesh_terms: D000818:Animals; D005440:Fluid Therapy; D006439:Hemodynamics / Q000187:drug effects; D008099:Liver / Q000293:injuries*; D012151:Resuscitation; D012771:Shock, Hemorrhagic / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D013552:Swine; D014667:Vasopressins / Q000627:therapeutic use*
chemical_list: D014667:Vasopressins