[Assessment of efficacy of hypertonic saline - hydroxyethylstarch in haemorrhagic shock].
OBJECTIVE
Assessment of haemodynamic, respiratory and renal effects of hypertonic saline-hydroxyethyl starch (HyperHES) in critically ill-patients with hemorrhagic shock.


METHODS
Seventeen mechanically ventilated patients with hemorragic shock benefiting from a cardiovascular monitoring by PiCCO device and requiring rapid volume loading. Two hundred and fifty milliliters of HyperHES were given over 5 minutes. The efficacy of volume loading was assessed by the measure of the systolic arterial pressure (SAP), cardiac index (CI), stroke volume variation (SVV) and the indexed systemic vascular resistance (iSVR). Studied parameters were assessed at baseline, 5, 30, 60 and 180 minutes after the end of HyperHES infusion.


RESULTS
SAP (105 + or - 23 vs 77 + or - 10; p<0.001) and CI (4.8 + or - 1.1 vs 3.5 + or - 0.9; p<0.001) were significantly increased whereas iSVR (1175 + or - 310 vs 1501 + or - 337; p<0.01) and SVV (13 + or - 7 vs 20 + or - 5; p<0.01) were significantly decreased 5 minutes after the HyperHES infusion. Sodium (145 + or - 6 vs 136 + or - 5; p<0.001) and chloride (118 + or - 7 vs 107 + or - 6; p<0.001) were increased 5 minutes after the infusion. The PaO(2)/FiO(2) ratio as the extravascular lung water was not influenced by the infusion. The follow-up of renal parameters during the three first days (creatinemia, uremia and diuresis) did not revelead significant variations.


CONCLUSIONS
In patients with hemorrhagic shock, the infusion of hypertonic saline (7.5%) hydroxyethyl starch association was followed by an increase in SAP, CI serum sodium and chloride concentrations.


METHODS
Prospective observational study.
Michelet
P
P
Réanimation des urgences, pôle réanimation urgences samu hyperbarie, hôpital Sainte-Marguerite, 270, boulevard Sainte-Marguerite, 13009 Marseille, France. pierre.michelet@ap-hm.fr
Bouzana
F
F
Couret
D
D
Delahaye
D
D
Perrin
G
G
Dourlens
L
L
Auffray
J-P
JP
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002712:Chlorides / Q000097:blood; D005260:Female; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D006895:Hydroxyethyl Starch Derivatives / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use; D006993:Hypnotics and Sedatives / Q000008:administration & dosage / Q000494:pharmacology; D007668:Kidney / Q000187:drug effects / Q000503:physiopathology; D008297:Male; D008874:Midazolam / Q000008:administration & dosage / Q000494:pharmacology; D008875:Middle Aged; D010952:Plasma Substitutes / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use*; D011183:Postoperative Complications / Q000628:therapy; D011446:Prospective Studies; D012121:Respiration, Artificial; D012771:Shock, Hemorrhagic / Q000097:blood / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D012964:Sodium / Q000097:blood; D017409:Sufentanil / Q000008:administration & dosage / Q000494:pharmacology; D014947:Wounds and Injuries / Q000150:complications; D055815:Young Adult
D002712:Chlorides; D006895:Hydroxyethyl Starch Derivatives; D006993:Hypnotics and Sedatives; D010952:Plasma Substitutes; D012964:Sodium; D017409:Sufentanil; D008874:Midazolam