[Small volume resuscitation for acute intraoperative haemorrhage: comparison of 7.5% saline and 6% hydroxyethyl starch].
BACKGROUND
The immediate effect of acute haemorrhage is a significant reduction in tissue blood flow, frequently resulting in haemorrhagic shock. The main aim of resuscitation after bleeding is the immediate restoration of intravascular volume. Intravenous administration of volume expanders should be commenced immediately, regardless of whether they are colloids or electrolytes. The purpose of the study was to analyze haemodynamic changes during intraoperative acute bleeding and to compare the effects of intravenous infusion with 7.5% saline solution to 6% starch solution on the volume resuscitation process.


METHODS
Sixty adult patients, of both sexes, in whom massive loss of blood followed by rapid cardiovascular collapse occurred during elective surgery, were enrolled in the study. In addition to standard fluid transfusion, all patients received either 4 mL kg(-1) of 7.5% NaCl solution or an equal volume of 6% of hydroxyethyl starch. Heart rate (HR) and mean arterial pressure (MAP) were noted. Cardiac output (CO) and systemic vascular resistance (SVR) were measured using a descending aortic blood flow ultrasound monitor.


RESULTS
Massive intraoperative haemorrhage resulted in a rapid decrease in CO and SV with a simultaneous increase in HR and SVR in all patients. Injection of hypertonic salt or 6% HAES over 5 min increased the CO and SV. HR and SVR returned quickly to pre-existing levels and remained so until the end of the procedures.


CONCLUSIONS
Small volume resuscitation with 7.5% saline or starch can be regarded as an efficient and effective method for restoring intravascular volume.
Ratajczak
Jerzy
J
Klinika Chirurgii Ogólnej i Hematologicznej Instytutu Hematologii i Transfuzjologii w Warszawie. jratajczak@ihit.waw.pl
Szczepanik
Andrzej B
AB
Meissner
Alfred J
AJ
Ostas
Alina
A
Wiszniewski
Adam
A
Bilski
Radosław
R
D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016063:Blood Loss, Surgical; D017558:Elective Surgical Procedures; D005260:Female; D006439:Hemodynamics; D006801:Humans; D006895:Hydroxyethyl Starch Derivatives / Q000008:administration & dosage*; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D010952:Plasma Substitutes / Q000008:administration & dosage*; D012151:Resuscitation / Q000379:methods*; D012771:Shock, Hemorrhagic / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D012965:Sodium Chloride / Q000008:administration & dosage*; D013997:Time Factors; D016896:Treatment Outcome; D014463:Ultrasonography
D006895:Hydroxyethyl Starch Derivatives; D010952:Plasma Substitutes; D012965:Sodium Chloride