title: Initial administration of hydroxyethyl starch vs lactated Ringer after liver trauma in the pig.
abstract: BACKGROUND
  This study tested the circulatory effectiveness of post-trauma administration of a large intravascular volume expander, hydroxyethyl starch 130/0.4 (HES), vs standard lactated Ringer's solution (RL).
  
  
  METHODS
  Liver injury was inflicted in 14 pigs [31 (4) kg; mean (sd)] and treatment simulated an acute pre-hospital event: after a standard first-respond delay (7 min), volume administration was provided in three phases to simulate increasing intravascular access. In the first two phases, the fluid was administered either by HES or by RL and, during the last phase, all animals received HES to stabilize the intravascular volume.
  
  
  RESULTS
  The liver trauma severed an equal number of 1-3 mm diameter blood vessels [1.4 (0.6)] and after 7 min, the blood loss was 184 (127) ml and mean arterial pressure had decreased by 19 (13) mm Hg (P<0.01). The intravascular volume expansion effect was 115 (25)% for HES and 76 (21)% for RL (P<0.05), yet oxygen uptake was maintained in zero of seven vs three of seven pigs and the survival was three of seven vs seven of seven, respectively (P<0.05). In these animals, the initial administration of HES provoked uncontrolled bleeding, whereas the administration of RL was associated with attenuated bleeding: total blood loss 2455 (1919) vs 311 (208) ml, respectively (P<0.01), reflecting that bleeding ceased in six of the pigs administered RL.
  
  
  CONCLUSIONS
  After injury, the intravascular volume expanding effect of HES was larger than that for RL. However, initial administration of HES provoked uncontrolled haemorrhage, suggesting that prioritizing intravascular volume expansion did not result in stabilization of the circulation after haemorrhage.
authors.affiliation: Department of Anaesthesia, Faculty of Health Sciences, University of Copenhagen, Denmark. morten.zaar@biology.au.dk
authors.forename: M
authors.initials: M
authors.lastname: Zaar
authors.forename: B
authors.initials: B
authors.lastname: Lauritzen
authors.forename: N H
authors.initials: NH
authors.lastname: Secher
authors.forename: T
authors.initials: T
authors.lastname: Krantz
authors.forename: H B
authors.initials: HB
authors.lastname: Nielsen
authors.forename: P L
authors.initials: PL
authors.lastname: Madsen
authors.forename: P I
authors.initials: PI
authors.lastname: Johansson
mesh_terms: D000818:Animals; D004353:Drug Evaluation, Preclinical / Q000379:methods; D005440:Fluid Therapy / Q000009:adverse effects / Q000379:methods; D006439:Hemodynamics; D006470:Hemorrhage / Q000209:etiology / Q000503:physiopathology / Q000628:therapy; D006895:Hydroxyethyl Starch Derivatives / Q000009:adverse effects / Q000627:therapeutic use*; D007552:Isotonic Solutions / Q000009:adverse effects / Q000627:therapeutic use*; D008099:Liver / Q000293:injuries*; D008107:Liver Diseases / Q000209:etiology / Q000503:physiopathology / Q000628:therapy; D010101:Oxygen Consumption; D010952:Plasma Substitutes / Q000009:adverse effects / Q000627:therapeutic use*; D000077325:Ringer's Lactate; D034421:Sus scrofa; D013916:Thrombelastography / Q000379:methods
chemical_list: C485123:HES 130-0.4; D006895:Hydroxyethyl Starch Derivatives; D007552:Isotonic Solutions; D010952:Plasma Substitutes; D000077325:Ringer's Lactate