Early vasopressin improves short-term survival after pulmonary contusion.
Arginine vasopressin (AVP) is a promising treatment for several types of irreversible shock, but its therapeutic potential has not been examined after severe chest trauma. Two series of experiments were performed to fill this gap.


METHODS
Series 1: anesthetized, mechanically-ventilated pigs (n = 20, 29 +/- 1 kg) received a blast to the chest, followed by a "controlled" arterial hemorrhage to a mean arterial pressure (MAP) <30 mm Hg. At 20 minutes, a 10 mL/kg normal saline (NS) bolus was followed by either 0.1 U/kg AVP bolus or NS, in randomized, blinded fashion. From 30-300 minutes, either AVP (0.4 U/kg/hr plus NS) or NS alone was infused as needed to MAP>70 mm Hg. Series 2: Swine (n = 15) received the chest injury followed by partial left hepatectomy to produce "uncontrolled" hemorrhage. Resuscitation was the same as in series 1.


RESULTS
The blast created bilateral parenchymal contusions (R > L), hemo/pneumothorax and progressive cardiopulmonary distress. In Series 1, there were 3/20 deaths before randomization, 0/8 deaths after resuscitation with AVP versus 4/9 deaths with NS (p = 0.029). In surviving animals, with AVP versus NS, fluid requirements and peak airway pressures were lower while P/F was higher (all p < 0.05). In Series 2, with uncontrolled hemorrhage, there were 5/15 deaths before randomization. Upon resuscitation with AVP versus NS, survival time and blood loss were both improved, but the differences did not reach statistical significance.


CONCLUSIONS
After severe chest trauma with controlled hemorrhage, early AVP decreased mortality, reduced fluid requirements and improved pulmonary function. With uncontrolled hemorrhage, early AVP did not increase the risk for bleeding.
Feinstein
Ara J
AJ
Dewitt Divisions of Trauma and Surgical Critical Care, Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, FL 33136, USA.
Cohn
Stephen M
SM
King
David R
DR
Sanui
Masamitsu
M
Proctor
Kenneth G
KG
D000818:Animals; D001127:Arginine Vasopressin / Q000627:therapeutic use*; D005260:Female; D005440:Fluid Therapy / Q000379:methods*; D006470:Hemorrhage / Q000628:therapy*; D006490:Hemostatics / Q000627:therapeutic use*; D008297:Male; D013552:Swine; D013898:Thoracic Injuries / Q000188:drug therapy*
D006490:Hemostatics; D001127:Arginine Vasopressin