title: A single bolus of 3% hypertonic saline with 6% dextran provides optimal initial resuscitation after uncontrolled hemorrhagic shock.
abstract: BACKGROUND
  The optimal fluid for early resuscitation of hemorrhagic shock would restore perfusion without increasing blood loss, hypothermia, acidosis, or coagulopathy. This study examined effects of a single bolus of hypertonic saline (HTS) with or without (+/-) dextran (D) after uncontrolled hemorrhage (UH) and determined optimal fluid composition.
  
  
  METHODS
  Fifty swine were anesthetized and underwent invasive line placement, celiotomy, splenectomy, suprapubic catheterization, and grade V liver injury. After 30 minutes of UH, blinded fluid resuscitation was initiated with a 250-mL bolus. Animals were randomized to five groups: normal saline (NS), 3% HTS (3%), 3% HTS/6% D (3% D), 7.5% HTS (7.5%), or 7.5% HTS/6% D (7.5% D). Mean arterial pressure (MAP) and tissue oxygen saturation (StO2) were recorded. Laboratory and thrombelastography (TEG) data were collected every 30 minutes. Animals were sacrificed 120 minutes after injury. Analysis of variance was used to compare groups. Significance was defined as p < 0.05.
  
  
  RESULTS
  Baseline characteristics and laboratory values were similar in all groups. All groups achieved a similar degree of shock. Two NS and two 3% animals did not survive to 120 minutes. Fluids containing dextran produced a significantly greater increase in MAP (p < 0.02). Animals receiving 3% D maintained a higher MAP 90 minutes after fluid bolus. Also, 7.5% +/- D produced a significantly greater initial increase in StO2 (p < 0.05). This effect declined after fluid bolus while 3% D continued to improve tissue oxygenation. Significant differences developed between groups in TEG values, hematocrit, fibrinogen, urine sodium, serum sodium, serum chloride, and urine output.
  
  
  CONCLUSIONS
  A single bolus of 3% D after uncontrolled hemorrhagic shock produces an adequate and sustained rise in MAP and StO2 and attenuates hypercoagulability. Resuscitation with 7.5% +/- D produces significantly increased urine output accompanied by a decline in MAP and StO2 over time. A single bolus of 7.5% D results in significant dilutional anemia and relative hypofibrinogenemia.
authors.affiliation: Oregon Health & Science University, Portland, Oregon 97239, USA. wattersj@ohsu.edu
authors.forename: Jennifer M
authors.initials: JM
authors.lastname: Watters
authors.forename: Brandon H
authors.initials: BH
authors.lastname: Tieu
authors.forename: Jerome A
authors.initials: JA
authors.lastname: Differding
authors.forename: Patrick J
authors.initials: PJ
authors.lastname: Muller
authors.forename: Martin A
authors.initials: MA
authors.lastname: Schreiber
mesh_terms: D000704:Analysis of Variance; D000818:Animals; D001794:Blood Pressure / Q000187:drug effects; D003911:Dextrans / Q000494:pharmacology / Q000627:therapeutic use*; D005260:Female; D005440:Fluid Therapy / Q000379:methods*; D010100:Oxygen / Q000378:metabolism; D011897:Random Allocation; D012462:Saline Solution, Hypertonic / Q000494:pharmacology / Q000627:therapeutic use*; D012771:Shock, Hemorrhagic / Q000628:therapy*; D016037:Single-Blind Method; D012965:Sodium Chloride / Q000494:pharmacology / Q000627:therapeutic use*; D013552:Swine; D013916:Thrombelastography
chemical_list: D003911:Dextrans; D012462:Saline Solution, Hypertonic; C104375:hypertonic saline-dextran solution; D012965:Sodium Chloride; D010100:Oxygen