title: Resuscitation from hemorrhagic shock: experimental model comparing normal saline, dextran, and hypertonic saline solutions.
abstract: OBJECTIVE
  To compare the effectiveness of normal saline, dextran, hypertonic, and hypertonic-hyperoncotic solutions in hemorrhagic shock.
  
  
  METHODS
  Laboratory investigation.
  
  
  METHODS
  University hospital, Emergency Surgery and Intensive Care staff.
  
  
  METHODS
  Thirty-two large white female pigs.
  
  
  METHODS
  Routine care included: anesthesia and sedation (ketamine 10 mg/kg, droperidol 0.25 mg/kg, diazepam 0.7 mg/kg, fentanyl 0.006 mg/kg, 2% enflurane, 20% nitrous oxide, pancuronium bromide 0.13 mg/kg); volume-controlled ventilation (Paco(2) 35-40 torr; 4.7-5.4 kPa); cannulation of right carotid artery and pulmonary artery. Three flow probes (subdiaphragmatic aorta, superior mesenteric artery, right renal artery) and regional venous catheters (superior mesenteric vein, right renal vein) were positioned. Animals were bled to 45 mm Hg for 1 hr and resuscitated with four different fluids and blood to normal aortic blood flow and hemoglobin.
  
  
  RESULTS
  Mean arterial pressure and blood flow through abdominal aorta ([OV0312](aor)), mesenteric artery ([OV0312](mes)), and renal artery ([OV0312](ren)) were continuously monitored. Cardiac output, systemic and regional oxygen delivery ([U1E0A]o(2), [U1E0A]o(2mes), [U1E0A]o(2ren)), and consumption ([OV0312]o(2), [OV0312]o(2mes), [OV0312]o(2ren)) were recorded every 30 mins. Baseline [OV0312](aor) was restored with different amounts of fluids in the four groups: normal saline (91.35 +/- 22.18 mL/kg); dextran (16.24 +/- 4.42 mL/kg); hypertonic (13.70 +/- 1.44 mL/kg); and hypertonic-hyperoncotic (9.11 +/- 1.20 mL/kg). The amount of sodium load was less using dextran and hypertonic-hyperoncotic and sodium levels were only transiently increased after hypertonic infusion. Mean arterial pressure and cardiac output were normalized in all groups. Animals resuscitated with normal saline and dextran showed increased pulmonary artery pressures. [U1E0A]o(2) was significantly higher after hypertonic-hyperoncotic infusion, because of reduced hemodilution. Hypertonic and hypertonic-hyperoncotic normalized [OV0312](mes), [U1E0A]o(2mes), [OV0312]o(2mes), [OV0312](ren), and [U1E0A]o(2ren), whereas normal saline and dextran did not achieve this result. At the end of the experiment, hypertonic-hyperoncotic maintained mean arterial pressure, cardiac output, and [U1E0A]o(2) until the end of observation in contrast to normal saline, dextran, and hypertonic.
  
  
  CONCLUSIONS
  Resuscitation with a small volume of hypertonic-hyperoncotic solution allows systemic and splanchnic hemodynamic and oxygen transport recovery, without an increase in pulmonary artery pressure. It only transiently increased sodium concentration.
authors.affiliation: Dipartimento Scienze Chirurgiche, Universita' delgi Studi di Milano, IRCCS Ospedale Maggiore, Italy. ochiara@yahoo.com
authors.forename: Osvaldo
authors.initials: O
authors.lastname: Chiara
authors.forename: Paolo
authors.initials: P
authors.lastname: Pelosi
authors.forename: Luca
authors.initials: L
authors.lastname: Brazzi
authors.forename: Nicola
authors.initials: N
authors.lastname: Bottino
authors.forename: Paolo
authors.initials: P
authors.lastname: Taccone
authors.forename: Stefania
authors.initials: S
authors.lastname: Cimbanassi
authors.forename: Marco
authors.initials: M
authors.lastname: Segala
authors.forename: Luciano
authors.initials: L
authors.lastname: Gattinoni
authors.forename: Thomas
authors.initials: T
authors.lastname: Scalea
mesh_terms: D000818:Animals; D002302:Cardiac Output / Q000187:drug effects / Q000502:physiology; D003911:Dextrans / Q000494:pharmacology*; D004305:Dose-Response Relationship, Drug; D005260:Female; D005440:Fluid Therapy / Q000379:methods*; D006439:Hemodynamics / Q000187:drug effects* / Q000502:physiology; D010100:Oxygen / Q000097:blood*; D011669:Pulmonary Wedge Pressure / Q000187:drug effects / Q000502:physiology; D012151:Resuscitation / Q000379:methods*; D012462:Saline Solution, Hypertonic / Q000494:pharmacology*; D012771:Shock, Hemorrhagic / Q000503:physiopathology / Q000628:therapy*; D012964:Sodium / Q000097:blood; D012965:Sodium Chloride / Q000494:pharmacology*; D013152:Splanchnic Circulation / Q000187:drug effects / Q000502:physiology; D013552:Swine
chemical_list: D003911:Dextrans; D012462:Saline Solution, Hypertonic; D012965:Sodium Chloride; D012964:Sodium; D010100:Oxygen