A comparison of vasopressin, terlipressin, and lactated ringers for resuscitation of uncontrolled hemorrhagic shock in an animal model.
OBJECTIVE
The aim of this study is to compare the effect of lactated ringer (LR), vasopressin (Vaso) or terlipressin (Terli) on uncontrolled hemorrhagic shock (UHS) in rats.


METHODS
48 rats were divided into four treatment groups for UHS study. Vaso group was given bolus vasopressin (0.8 U/kg); the Terli group was given bolus terlipressin (15 mcg/kg); LR group was given LR and the sham group was not given anything. Mean arterial pressure (MAP), serum lactate level, plasma cytokine levels, lung injury and mortality are investigated for these different treatment groups.


RESULTS
Compared with LR group, vasopressin and terlipressin-treated groups were associated with higher MAP, lowered mortality rates, less lung injury, lowered serum lactate level, less proinflammatory and more anti-inflammatory cytokine production at certain time points. Comparing between vasopressin and terlipressin treated groups, there is no statistical difference in mortality rates, lung injury, serum lactate level and cytokine level. However, there is a difference in the length of time in maintaining a restored level of MAP (80 to 110 mmHg). The terlipressin treated rats can maintain this restored level of MAP for 45 minutes, but the vasopressin treated rats can only maintain this restored level of MAP for 5 minutes before decreasing gradually to the MAP observed in LR group (40 mmHg).


CONCLUSIONS
Early optimization of hemodynamics with terlipressin or vasopressin in an animal model of UHS was associated with improved hemodynamics and inflammatory cytokine profile than the LR control. Compared with vasopressin, terlipressin has the advantage of ease of use and sustained effects.
Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan.
Chien-Chang
CC
Lee
Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan.
Meng-Tse Gabriel
MT
Lee
Graduate Institute of Clinical Medical Sciences, Chang Gung University, Taoyuan, Taiwan; Department of Family Medicine and Emergency Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan.
Shy-Shin
SS
Chang
Department of Rehabilitation and Physical Medicine, National Yang-Ming University and Taipei Veterans General Hospital, National Yang-Ming University, Taipei, Taiwan; Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, National Yang-Ming University, Taipei, Taiwan.
Si-Huei
SH
Lee
Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan.
Yu-Chi
YC
Huang
Department of Emergency Medicine, Far Eastern Memorial Hospital, Taipei, Taiwan.
Chia-Hung
CH
Yo
Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan.
Shih-Hao
SH
Lee
Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan.
Shyr-Chyr
SC
Chen
D000818:Animals; D004195:Disease Models, Animal; D007552:Isotonic Solutions / Q000627:therapeutic use*; D008236:Lypressin / Q000031:analogs & derivatives* / Q000627:therapeutic use; D008297:Male; D051381:Rats; D017208:Rats, Wistar; D000077325:Ringer's Lactate; D012771:Shock, Hemorrhagic / Q000188:drug therapy*; D000077585:Terlipressin; D014667:Vasopressins / Q000627:therapeutic use*
D007552:Isotonic Solutions; D000077325:Ringer's Lactate; D014667:Vasopressins; D008236:Lypressin; D000077585:Terlipressin