title: Blood loss after fluid resuscitation with isotonic or hypertonic saline for the initial treatment of uncontrolled hemorrhage induced by spleen rupture.
abstract: BACKGROUND
  It has been suggested that fluid resuscitation for the prehospital management of hypotensive trauma victims increases bleeding. In a model of uncontrolled hemorrhage induced by complete splenic laceration with a hilar vascular injury, we hypothesized that small-volume hypertonic saline or large-volume lactated Ringer's solution may provide sustained hemodynamic benefits despite promoting increases in intra-abdominal bleeding.
  
  
  METHODS
  Forty anesthetized, spontaneously breathing dogs (18 +/- 1 kg) underwent laparotomy. A suture line was placed around the spleen to produce a splenic rupture with hilar vascular injury by pulling the exteriorized lines after incision closure. Intra-abdominal blood loss was measured directly, immediately after the animal was killed. Dogs were randomly assigned to four groups (n = 10 per group): Untreated controls were killed 20 (CT20) or 40 (CT40) minutes after splenic rupture to measure blood loss directly. Treatment groups received (20 minutes after spleen rupture) lactated Ringer's (LR), 33 mL/kg over 15 minutes, or 7.5% NaCl/6% dextran 70 (HSD), 4 mL/kg over 4 minutes. Blood loss was measured 40 minutes after spleen rupture.
  
  
  RESULTS
  Mean arterial pressure dropped from an average value of 103 +/- 3 mm Hg to 67 +/- 5 mm Hg during the first 20 minutes and was partially restored afterward in all groups, with no significant differences between them. No resuscitation was associated with low cardiac output, whereas HSD restored and LR overshot baseline cardiac output. Intra-abdominal blood loss was 30 +/- 4, 38 +/- 4, 43 +/- 5, and 42 +/- 5 mL/kg for groups CT20, CT40, HSD, and LR, respectively, with no statistical significance between groups.
  
  
  CONCLUSIONS
  No-fluid resuscitation in uncontrolled hemorrhage from splenic rupture resulted in a low-flow state, whereas resuscitation with small volumes of HSD or large volumes of LR produced hemodynamic benefits without significant increases in bleeding.
authors.affiliation: Research Division, University of São Paulo Medical School, São Paulo, Brazil.
authors.forename: Edson Y
authors.initials: EY
authors.lastname: Varicoda
authors.forename: Luiz F
authors.initials: LF
authors.lastname: Poli de Figueiredo
authors.forename: Ruy J
authors.initials: RJ
authors.lastname: Cruz
authors.forename: Leonardo E
authors.initials: LE
authors.lastname: Silva
authors.forename: Mauricio
authors.initials: M
authors.lastname: Rocha e Silva
mesh_terms: D000818:Animals; D004285:Dogs; D005440:Fluid Therapy / Q000379:methods*; D006439:Hemodynamics; D006470:Hemorrhage / Q000209:etiology / Q000628:therapy*; D007552:Isotonic Solutions / Q000627:therapeutic use*; D008297:Male; D000077325:Ringer's Lactate; D012462:Saline Solution, Hypertonic / Q000627:therapeutic use*; D013161:Splenic Rupture / Q000150:complications*
chemical_list: D007552:Isotonic Solutions; D000077325:Ringer's Lactate; D012462:Saline Solution, Hypertonic