Comparison of lactated Ringer's, gelatine and blood resuscitation on intestinal oxygen supply and mucosal tissue oxygen tension in haemorrhagic shock.
OBJECTIVE
To evaluate the effects on intestinal oxygen supply, and mucosal tissue oxygen tension during haemorrhage and after fluid resuscitation with either blood (B; n=7), gelatine (G; n=8), or lactated Ringer's solution (R; n=8) in an autoperfused, innervated jejunal segment in anaesthetized pigs.


METHODS
To induce haemorrhagic shock, 50% of calculated blood volume was withdrawn. Systemic haemodynamics, mesenteric venous and systemic acid-base and blood gas variables, and lactate measurements were recorded. A flowmeter was used for measuring mesenteric arterial blood flow. Mucosal tissue oxygen tension (PO(2)muc), jejunal microvascular haemoglobin oxygen saturation (HbO(2)) and microvascular blood flow were measured. Measurements were performed at baseline, after haemorrhage and at four 20 min intervals after fluid resuscitation. After haemorrhage, animals were retransfused with blood, gelatine or lactated Ringer's solution until baseline pulmonary capillary wedge pressure was reached.


RESULTS
After resuscitation, no significant differences in macrohaemodynamic parameters were observed between groups. Systemic and intestinal lactate concentration was significantly increased in animals receiving lactated Ringer's solution [5.6 (1.1) vs 3.3 (1.1) mmol litre(-1); 5.6 (1.1) vs 3.3 (1.2) mmol litre(-1)]. Oxygen supply to the intestine was impaired in animals receiving lactated Ringer's solution when compared with animals receiving blood. Blood and gelatine resuscitation resulted in higher HbO(2) than with lactated Ringer's resuscitation after haemorrhagic shock [B, 43.8 (10.4)%; G, 34.6 (9.4)%; R, 28.0 (9.3)%]. PO(2)muc was better preserved with gelatine resuscitation when compared with lactated Ringer's or blood resuscitation [20.0 (8.8) vs 13.8 (7.1) mm Hg, 15.2 (7.2) mm Hg, respectively].


CONCLUSIONS
Blood or gelatine infusion improves mucosal tissue oxygenation of the porcine jejunum after severe haemorrhage when compared with lactated Ringer's solution.
Knotzer
H
H
Department of Anaesthesiology and Critical Care Medicine, Innsbruck Medical University, Innsbruck, Austria. johann.knotzer@uibk.ac.at
Pajk
W
W
Maier
S
S
Dünser
M W
MW
Ulmer
H
H
Schwarz
B
B
Salak
N
N
Hasibeder
W R
WR
D000818:Animals; D001803:Blood Transfusion; D005440:Fluid Therapy / Q000379:methods; D005780:Gelatin / Q000627:therapeutic use*; D006439:Hemodynamics; D007413:Intestinal Mucosa / Q000098:blood supply; D007552:Isotonic Solutions / Q000627:therapeutic use*; D007583:Jejunum / Q000098:blood supply*; D008638:Mesenteric Arteries / Q000503:physiopathology; D010100:Oxygen / Q000097:blood*; D010101:Oxygen Consumption; D010313:Partial Pressure; D012039:Regional Blood Flow; D000077325:Ringer's Lactate; D012771:Shock, Hemorrhagic / Q000097:blood / Q000503:physiopathology / Q000628:therapy*; D013552:Swine
D007552:Isotonic Solutions; D000077325:Ringer's Lactate; D005780:Gelatin; D010100:Oxygen