title: Terlipressin with limited fluid resuscitation in a swine model of hemorrhage.
abstract: BACKGROUND
  Principles of damage control resuscitation include minimizing intravenous fluid (IVF) administration while correcting perfusion pressure as quickly as possible. Recent studies have identified a potential advantage of vasopressin over catecholamines in traumatic shock. Terlipressin (TP) is a vasopressin analogue used to reverse certain shock etiologies in some European countries.
  
  
  OBJECTIVE
  We evaluated three dosages of TP when combined with a limited colloid resuscitation strategy on mean arterial pressure (MAP) and lactatemia in a swine model of isolated hemorrhage.
  
  
  METHODS
  Sixty anesthetized swine underwent intubation and severe hemorrhage. Subjects were randomized to one of four resuscitation groups: 4 mL/kg Hextend(®) (Hospira Inc, Lake Forest, IL) only, 3.75 μg/kg TP + Hextend, 7.5 μg/kg TP + Hextend, or 15 μg/kg TP + Hextend. MAP and heart rate were recorded every 5 min. Baseline and serial lactate values at 30-min intervals were recorded and compared.
  
  
  RESULTS
  Subjects receiving 7.5 μg/kg TP had significantly higher MAPs at times t15 (p = 0.012), t20 (p = 0.004), t25 (p = 0.018), t30 (p = 0.032), t35 (p = 0.030), and t40 (p = 0.021). No statistically significant differences in lactate values between TP groups and controls were observed.
  
  
  CONCLUSIONS
  Subjects receiving 7.5 μg/kg of TP demonstrated improved MAP within 10 min of administration. When combined with minimal IVF resuscitation, TP doses between 3.75 and 15 μg/kg do not elevate lactate levels in hemorrhaged swine.
authors.affiliation: Department of Emergency Medicine, Naval Medical Center Portsmouth, Portsmouth, Virginia, USA.
authors.forename: John J
authors.initials: JJ
authors.lastname: Devlin
authors.forename: Sara S
authors.initials: SS
authors.lastname: DeVito
authors.forename: Lanny F
authors.initials: LF
authors.lastname: Littlejohn
authors.forename: Miguel A
authors.initials: MA
authors.lastname: Gutierrez
authors.forename: Gosia
authors.initials: G
authors.lastname: Nowak
authors.forename: José
authors.initials: J
authors.lastname: Henao
authors.forename: Anthony
authors.initials: A
authors.lastname: Bielawski
authors.forename: Joseph
authors.initials: J
authors.lastname: Kotora
authors.forename: Andrew S
authors.initials: AS
authors.lastname: Johnson
mesh_terms: D000818:Animals; D062186:Arterial Pressure / Q000187:drug effects; D004195:Disease Models, Animal; D005440:Fluid Therapy; D006339:Heart Rate / Q000187:drug effects; D006470:Hemorrhage / Q000188:drug therapy* / Q000628:therapy; D019344:Lactic Acid / Q000097:blood; D008236:Lypressin / Q000008:administration & dosage / Q000031:analogs & derivatives*; D013552:Swine; D000077585:Terlipressin; D014662:Vasoconstrictor Agents / Q000008:administration & dosage*
chemical_list: D014662:Vasoconstrictor Agents; D019344:Lactic Acid; D008236:Lypressin; D000077585:Terlipressin