title: Does the type of fluid affect rapidity of shock reversal in an anaesthetized-piglet model of near-fatal controlled haemorrhage? A randomized study.
abstract: BACKGROUND
  The optimal resuscitation fluid for the early treatment of severe bleeding patients remains highly debated. The objective of this experimental study was to compare the rapidity of shock reversal with lactated Ringer (LR) or hydroxyethyl starch (HES) 130/0.4 at the early phase of controlled haemorrhagic shock. To assess the influence of vascular permeability in this model, we measured plasma vascular endothelial growth factor (VEGF) levels during the experiment.
  
  
  METHODS
  Thirty-six anaesthetized and mechanically ventilated piglets were bled (<30 ml kg(-1)) to hold mean arterial pressure (MAP) at 40 mm Hg for more than 30 min and were resuscitated in two randomized groups: LR (n=14) or HES (n=14) at 1 ml kg(-1) min(-1) until MAP reached its baseline value of ±10%. MAP was maintained at its baseline value for 1 h. The time and fluid volume necessary to restore the baseline MAP value were measured.
  
  
  RESULTS
  The time to restore the baseline MAP value of ±10% was significantly lower in the HES group (P<0.001). During the initial resuscitation phase, the infused volume was 279 (119) ml in the HES group and 1011 (561) ml in the LR group (P<0.0001). During the stabilization phase, the infused volume was 119 (124) ml in the HES group and 541 (506) ml in the LR group. Biological data and plasma VEGF levels were similar between the groups.
  
  
  CONCLUSIONS
  Restoration of MAP was four times faster with HES than with LR in the early phase of controlled haemorrhagic shock. However, there was no evidence of increased vascular permeability.
authors.affiliation: Department of Anesthesiology, Emergency and Critical Care Medicine and Research team EA2992, Montpellier 1 University, Chemin du Carreau de Lanes, Nimes, France.
authors.forename: C
authors.initials: C
authors.lastname: Roger
authors.affiliation: Department of Anesthesiology, Emergency and Critical Care Medicine and Research team EA2992, Montpellier 1 University, Chemin du Carreau de Lanes, Nimes, France laurent.muller27@orange.fr.
authors.forename: L
authors.initials: L
authors.lastname: Muller
authors.affiliation: Department of Anesthesiology, Emergency and Critical Care Medicine and.
authors.forename: P
authors.initials: P
authors.lastname: Deras
authors.affiliation: Department of Anesthesiology, Emergency and Critical Care Medicine and Research team EA2992, Montpellier 1 University, Chemin du Carreau de Lanes, Nimes, France.
authors.forename: G
authors.initials: G
authors.lastname: Louart
authors.affiliation: Haematology Laboratory, Nimes University Hospital, Place du Pr Debré, Nîmes 30029, France.
authors.forename: E
authors.initials: E
authors.lastname: Nouvellon
authors.affiliation: Department of Biostatistics, UMR 729 MISTEA, Montpellier University Hospital, Avenue Gaston Giraud, Montpellier 34093, France.
authors.forename: N
authors.initials: N
authors.lastname: Molinari
authors.affiliation: Research team EA2992, Montpellier 1 University, Chemin du Carreau de Lanes, Nimes, France.
authors.forename: L
authors.initials: L
authors.lastname: Goret
authors.affiliation: Haematology Laboratory, Nimes University Hospital, Place du Pr Debré, Nîmes 30029, France Research team EA2992, Montpellier 1 University, Chemin du Carreau de Lanes, Nimes, France.
authors.forename: J C
authors.initials: JC
authors.lastname: Gris
authors.affiliation: Department of Anesthesiology, Emergency and Critical Care Medicine and Research team EA2992, Montpellier 1 University, Chemin du Carreau de Lanes, Nimes, France.
authors.forename: J
authors.initials: J
authors.lastname: Ripart
authors.affiliation: Department of Anesthesiology, Emergency and Critical Care Medicine and Research team EA2992, Montpellier 1 University, Chemin du Carreau de Lanes, Nimes, France.
authors.forename: J E
authors.initials: JE
authors.lastname: de La Coussaye
authors.affiliation: Department of Anesthesiology, Emergency and Critical Care Medicine and Research team EA2992, Montpellier 1 University, Chemin du Carreau de Lanes, Nimes, France.
authors.forename: J Y
authors.initials: JY
authors.lastname: Lefrant
mesh_terms: D000818:Animals; D001794:Blood Pressure / Q000187:drug effects; D002199:Capillary Permeability / Q000187:drug effects; D004195:Disease Models, Animal; D005440:Fluid Therapy / Q000379:methods*; D006895:Hydroxyethyl Starch Derivatives / Q000097:blood / Q000627:therapeutic use*; D007552:Isotonic Solutions / Q000627:therapeutic use*; D010952:Plasma Substitutes / Q000627:therapeutic use*; D011897:Random Allocation; D012151:Resuscitation / Q000379:methods*; D000077325:Ringer's Lactate; D012771:Shock, Hemorrhagic / Q000097:blood / Q000188:drug therapy*; D013552:Swine; D013997:Time Factors; D042461:Vascular Endothelial Growth Factor A / Q000097:blood
chemical_list: D006895:Hydroxyethyl Starch Derivatives; D007552:Isotonic Solutions; D010952:Plasma Substitutes; D000077325:Ringer's Lactate; D042461:Vascular Endothelial Growth Factor A
keywords: bleeding; laboratory animal model; resuscitation; shock