Blood loss and transcapillary refill in uncontrolled treated hemorrhage in dogs.
OBJECTIVE
This study evaluated retroperitoneal hematomas produced by bilateral injury of iliac arteries (uncontrolled hemorrhage), blood volume loss, transcapillary refill, the effects of volume replacement on retroperitoneal bleeding and the hemodynamic changes with and without treatment.


METHODS
Initial blood volume was determined with Tc(99m)-labelled red cells, and bleeding was evaluated by means of a portable scintillation camera positioned over the abdomen. Previously splenectomized mongrel dogs (16.8 +/- 2.2 kg) were submitted to hemorrhage for 30 minutes and randomized into three groups: I - no treatment (n=7); II - treatment with 32 mL/kg of Lactated Ringer's for three to five minutes (n=7); and III - treatment with 4 mL/kg of 7.5% NaCl plus 6.0% dextran 70 for three to five minutes (n=7). They were studied for an additional 45 minutes.


RESULTS
Volume replacement produced transitory recovery in hemodynamic variables, including mean pulmonary artery pressure, pulmonary capillary wedge pressure and cardiac index, with significant increase in dogs treated with 32 mL/kg of Lactated Ringer's and 7.5% NaCl plus 6.0% dextran 70 (p<0.001, against no treatment), along with a decrease (p<0.001) in the systemic vascular resistance index. Groups II and III had significant initial decreases in hematocrit and hemoglobin. The treated dogs (groups II and III) presented rebleeding, which was greater during treatment with 32 mL/kg of Lactated Ringer's (group II).


CONCLUSIONS
Despite the rebleeding observed in treated groups, the utilization of hypertonic saline solution with dextran proved to be effective in the initial reanimation, producing evident transcapillary refill, while the Lactated Ringer's solution produced capillary extravasation and was ineffective in the initial volume replacement in this model of uncontrolled hemorrhage.
Sallum
Elias Aissar
EA
Departamento de Cirurgia, Divisão de Cirurgia Geral do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo - São Paulo/SP, Brazil. easallum.fnr@terra.com.br
Sinozaki
Sueli
S
Calil
Ana Maria
AM
Coimbra
Raul
R
Silva
Maurício Rocha E
MR
Figueiredo
Luis Francisco Poli de
LF
Birolini
Dario
D
D000704:Analysis of Variance; D000818:Animals; D001810:Blood Volume / Q000187:drug effects*; D002196:Capillaries / Q000187:drug effects; D003911:Dextrans / Q000627:therapeutic use*; D004195:Disease Models, Animal; D004285:Dogs; D005440:Fluid Therapy / Q000379:methods* / Q000592:standards; D006471:Gastrointestinal Hemorrhage / Q000188:drug therapy* / Q000503:physiopathology; D006406:Hematoma / Q000188:drug therapy* / Q000503:physiopathology; D006439:Hemodynamics / Q000187:drug effects; D007083:Iliac Artery / Q000293:injuries; D007552:Isotonic Solutions / Q000627:therapeutic use; D008297:Male; D011897:Random Allocation; D012187:Retroperitoneal Space / Q000098:blood supply; D000077325:Ringer's Lactate; D012462:Saline Solution, Hypertonic / Q000627:therapeutic use; D012771:Shock, Hemorrhagic / Q000188:drug therapy
D003911:Dextrans; D007552:Isotonic Solutions; D000077325:Ringer's Lactate; D012462:Saline Solution, Hypertonic