title: Midterm effects of fluid resuscitation strategies in an experimental model of lung contusion and hemorrhagic shock.
abstract: BACKGROUND
  This study compared three different fluid resuscitation strategies in terms of respiratory tolerance and hemodynamic efficacy in a pig model of blunt chest trauma with lung contusion and controlled hemorrhagic shock. We hypothesized that the choice of fluid resuscitation strategy (type and amount of fluids) may impact differently contused lungs in terms of extravascular lung water (EVLW) 20 h after trauma.
  
  
  METHODS
  Anesthetized female pigs (n = 5/group) received five bolt shots to the right thoracic cage and allowed to hemorrhage for 30 min, with 25 to 30 mL/kg of blood loss. Pigs were randomly assigned to resuscitation groups that maintained a minimum mean arterial blood pressure of 70 mmHg with one of three methods: normal saline (NS), unrestricted normal saline; NOREPI, low-volume normal saline with norepinephrine; or HS-HES, hypertonic saline with hydroxyethyl starch. Control pigs were anesthetized, but received no injury or treatment. After 20 h, animals were killed to measure EVLW by gravimetry.
  
  
  RESULTS
  Fluid loading was significantly different in each group. All three treatment groups had higher EVLW than controls. Moderate, bilateral pulmonary edema was observed in the NS and HS-HES groups. The three treatment groups showed similar reductions in oxygenation. Static pulmonary compliance was diminished in the NS and HS-HES groups, but compliance was similar in NOREPI and control groups. The NOREPI group had pathological lactate levels.
  
  
  CONCLUSIONS
  This study demonstrated the impact of fluid resuscitation on contused lungs. Twenty hours after the trauma, all three resuscitation approaches showed modest clinical consequences, with moderate lung edema and reduced compliance in response to the infused volume.
authors.affiliation: *Intensive Care Unit, Sainte Anne Military Teaching Hospital, Toulon; and †UMR MD2, P2COE, University of Aix-Marseille, School of Medicine, Marseille, France; ‡U.S. Army Institute of Surgical Research, Fort Sam Houston, Texas; and §Department of Emergency Medicine and Intensive Care, Timone University Hospital, Marseille; and ∥Intensive Care Unit, Laveran Military Teaching Hospital; and ¶Department of Anesthesiology, Pique Military Teaching Hospital, Bordeaux, France.
authors.forename: Bertrand
authors.initials: B
authors.lastname: Prunet
authors.forename: Nicolas
authors.initials: N
authors.lastname: Prat
authors.forename: David
authors.initials: D
authors.lastname: Couret
authors.forename: Pierre-Yves
authors.initials: PY
authors.lastname: Cordier
authors.forename: Sophie
authors.initials: S
authors.lastname: De Bourmont
authors.forename: Dominique
authors.initials: D
authors.lastname: Lambert
authors.forename: Yves
authors.initials: Y
authors.lastname: Asencio
authors.forename: Eric
authors.initials: E
authors.lastname: Meaudre
authors.forename: Pierre
authors.initials: P
authors.lastname: Michelet
mesh_terms: D055371:Acute Lung Injury / Q000209:etiology / Q000628:therapy; D000818:Animals; D003288:Contusions; D015633:Extravascular Lung Water / Q000378:metabolism*; D005260:Female; D005440:Fluid Therapy / Q000379:methods*; D006895:Hydroxyethyl Starch Derivatives / Q000627:therapeutic use*; D009638:Norepinephrine / Q000627:therapeutic use; D011654:Pulmonary Edema / Q000209:etiology / Q000628:therapy*; D012462:Saline Solution, Hypertonic / Q000627:therapeutic use; D012771:Shock, Hemorrhagic / Q000628:therapy*; D013552:Swine; D013898:Thoracic Injuries; D014949:Wounds, Nonpenetrating
chemical_list: D006895:Hydroxyethyl Starch Derivatives; D012462:Saline Solution, Hypertonic; D009638:Norepinephrine