title: Hextend and 7.5% hypertonic saline with Dextran are equivalent to Lactated Ringer's in a swine model of initial resuscitation of uncontrolled hemorrhagic shock.
abstract: BACKGROUND
  The optimal fluid strategy for the early treatment of trauma patients remains highly debated. Our objective was to determine the efficacy of an initial bolus of resuscitative fluids used in military and civilian settings on the physiologic response to uncontrolled hemorrhagic shock in a prospective, randomized, blinded animal study.
  
  
  METHODS
  Fifty anesthetized swine underwent central venous and arterial catheterization followed by celiotomy. Grade V liver injury was performed, followed by 30 minutes of uncontrolled hemorrhage. Then, liver packing was completed, and fluid resuscitation was initiated over 12 minutes with 2 L normal saline (NS), 2 L Lactated Ringer's (LR), 250 mL 7.5% hypertonic saline with 3% Dextran (HTS), 500 mL Hextend (HEX), or no fluid (NF). Animals were monitored for 2 hours postinjury. Blood loss after initial hemorrhage, mean arterial pressure (MAP), tissue oxygen saturation (StO2), hematocrit, pH, base excess, and lactate were measured at baseline, 1 hour, and 2 hours.
  
  
  RESULTS
  NF group had less post-treatment blood loss compared with other groups. MAP and StO2 for HEX, HTS, and LR at 1 hour and 2 hours were similar and higher than NF. MAP and StO2 did not differ between NS and NF, but NS resulted in decreased pH and base excess.
  
  
  CONCLUSIONS
  Withholding resuscitative fluid results in the least amount of posttreatment blood loss. In clinically used volumes, HEX and HTS are equivalent to LR with regard to physiologic outcomes and superior to NF. NS did not provide a measurable improvement in outcome compared with NF and resulted in increased acidosis.
authors.affiliation: Division of Trauma, Critical Care, and Acute Care Surgery, Department of Surgery, Oregon Health & Science University, Portland, Oregon 97239, USA.
authors.forename: Gordon M
authors.initials: GM
authors.lastname: Riha
authors.forename: Nicholas R
authors.initials: NR
authors.lastname: Kunio
authors.forename: Philbert Y
authors.initials: PY
authors.lastname: Van
authors.forename: Gregory J
authors.initials: GJ
authors.lastname: Hamilton
authors.forename: Ross
authors.initials: R
authors.lastname: Anderson
authors.forename: Jerome A
authors.initials: JA
authors.lastname: Differding
authors.forename: Martin A
authors.initials: MA
authors.lastname: Schreiber
mesh_terms: D000818:Animals; D004195:Disease Models, Animal; D005260:Female; D005440:Fluid Therapy / Q000379:methods; D006439:Hemodynamics / Q000502:physiology; D006895:Hydroxyethyl Starch Derivatives / Q000494:pharmacology*; D007552:Isotonic Solutions / Q000494:pharmacology*; D010952:Plasma Substitutes / Q000494:pharmacology; D011897:Random Allocation; D012151:Resuscitation / Q000379:methods*; D000077325:Ringer's Lactate; D018570:Risk Assessment; D012462:Saline Solution, Hypertonic / Q000494:pharmacology*; D012771:Shock, Hemorrhagic / Q000401:mortality* / Q000628:therapy*; D016037:Single-Blind Method; D015996:Survival Rate; D034421:Sus scrofa; D013552:Swine; D016896:Treatment Outcome
chemical_list: D006895:Hydroxyethyl Starch Derivatives; D007552:Isotonic Solutions; D010952:Plasma Substitutes; D000077325:Ringer's Lactate; D012462:Saline Solution, Hypertonic