title: Comparison of normal saline, hypertonic saline albumin and terlipressin plus hypertonic saline albumin in an infant animal model of hypovolemic shock.
abstract: BACKGROUND
  In series of cases and animal models suffering hemorrhagic shock, the use of vasopressors has shown potential benefits regarding hemodynamics and tissue perfusion. Terlipressin is an analogue of vasopressin with a longer half-life that can be administered by bolus injection. We have previously observed that hypertonic albumin improves resuscitation following controlled hemorrhage in piglets. The aim of the present study was to analyze whether the treatment with the combination of terlipressin and hypertonic albumin can produce better hemodynamic and tissular perfusion parameters than normal saline or hypertonic albumin alone at early stages of hemorrhagic shock in an infant animal model.
  
  
  METHODS
  Experimental, randomized animal study including 39 2-to-3-month-old piglets. Thirty minutes after controlled 30 ml/kg bleed, pigs were randomized to receive either normal saline (NS) 30 ml/kg (n = 13), 5% albumin plus 3% hypertonic saline (AHS) 15 ml/kg (n = 13) or single bolus of terlipressin 15 μg/kg i.v. plus 5% albumin plus 3% hypertonic saline 15 ml/kg (TAHS) (n = 13) over 30 minutes. Global hemodynamic and tissular perfusion parameters were compared.
  
  
  RESULTS
  After controlled bleed a significant decrease of blood pressure, cardiac index, central venous saturation, carotid and peripheral blood flow, brain saturation and an increase of heart rate, gastric PCO2 and lactate was observed. After treatment no significant differences in most hemodynamic (cardiac index, mean arterial pressure) and perfusion parameters (lactate, gastric PCO2, brain saturation, cutaneous blood flow) were observed between the three therapeutic groups. AHS and TAHS produced higher increase in stroke volume index and carotid blood flow than NS.
  
  
  CONCLUSIONS
  In this pediatric animal model of hypovolemic shock, albumin plus hypertonic saline with or without terlipressin achieved similar hemodynamics and perfusion parameters than twice the volume of NS. Addition of terlipressin did not produce better results than AHS.
authors: Pediatric Intensive Care Department, Gregorio Marañon University Hospital, Madrid, Spain, and Instituto de Investigación Sanitaria Hospital Gregorio Marañón (IiSGM), Research Network on Maternal and Child Health and Development (RedSAMID II), Spanish Health Institute Carlos III, Madrid, Spain; Health Research Fund, Spanish Health Institute Carlos III, Madrid, Spain.
authors: Javier
authors: J
authors: Urbano
authors: Pediatric Intensive Care Department, Gregorio Marañon University Hospital, Madrid, Spain, and Instituto de Investigación Sanitaria Hospital Gregorio Marañón (IiSGM), Research Network on Maternal and Child Health and Development (RedSAMID II), Spanish Health Institute Carlos III, Madrid, Spain; Health Research Fund, Spanish Health Institute Carlos III, Madrid, Spain.
authors: Rafael
authors: R
authors: González
authors: Pediatric Intensive Care Department, Gregorio Marañon University Hospital, Madrid, Spain, and Instituto de Investigación Sanitaria Hospital Gregorio Marañón (IiSGM), Research Network on Maternal and Child Health and Development (RedSAMID II), Spanish Health Institute Carlos III, Madrid, Spain; Health Research Fund, Spanish Health Institute Carlos III, Madrid, Spain.
authors: Jorge
authors: J
authors: López
authors: Pediatric Intensive Care Department, Gregorio Marañon University Hospital, Madrid, Spain, and Instituto de Investigación Sanitaria Hospital Gregorio Marañón (IiSGM), Research Network on Maternal and Child Health and Development (RedSAMID II), Spanish Health Institute Carlos III, Madrid, Spain.
authors: María J
authors: MJ
authors: Solana
authors: Preventive and Quality Control Service, Instituto de Investigación Sanitaria del Hospital Gregorio Marañón Madrid (IiSGM), Madrid, Spain.
authors: José M
authors: JM
authors: Bellón
authors: Pediatric Intensive Care Department, Gregorio Marañon University Hospital, Madrid, Spain, and Instituto de Investigación Sanitaria Hospital Gregorio Marañón (IiSGM), Research Network on Maternal and Child Health and Development (RedSAMID II), Spanish Health Institute Carlos III, Madrid, Spain.
authors: Marta
authors: M
authors: Botrán
authors: Pediatric Intensive Care Department, Gregorio Marañon University Hospital, Madrid, Spain, and Instituto de Investigación Sanitaria Hospital Gregorio Marañón (IiSGM), Research Network on Maternal and Child Health and Development (RedSAMID II), Spanish Health Institute Carlos III, Madrid, Spain.
authors: Ana
authors: A
authors: García
authors: Pediatric Intensive Care Department, Gregorio Marañon University Hospital, Madrid, Spain, and Instituto de Investigación Sanitaria Hospital Gregorio Marañón (IiSGM), Research Network on Maternal and Child Health and Development (RedSAMID II), Spanish Health Institute Carlos III, Madrid, Spain.
authors: Sarah N
authors: SN
authors: Fernández
authors: Pediatric Intensive Care Department, Gregorio Marañon University Hospital, Madrid, Spain, and Instituto de Investigación Sanitaria Hospital Gregorio Marañón (IiSGM), Research Network on Maternal and Child Health and Development (RedSAMID II), Spanish Health Institute Carlos III, Madrid, Spain; Health Research Fund, Spanish Health Institute Carlos III, Madrid, Spain.
authors: Jesús
authors: J
authors: López-Herce
mesh_terms: D000418:Albumins / Q000494:pharmacology / Q000627:therapeutic use*; D000818:Animals; D000831:Animals, Newborn; D001794:Blood Pressure / Q000187:drug effects; D002245:Carbon Dioxide / Q000378:metabolism; D004195:Disease Models, Animal; D006339:Heart Rate / Q000187:drug effects; D006439:Hemodynamics / Q000187:drug effects; D006470:Hemorrhage / Q000473:pathology / Q000503:physiopathology; D020896:Hypovolemia / Q000188:drug therapy* / Q000503:physiopathology; D008236:Lypressin / Q000031:analogs & derivatives* / Q000494:pharmacology / Q000627:therapeutic use; D010100:Oxygen / Q000097:blood; D012462:Saline Solution, Hypertonic / Q000494:pharmacology / Q000627:therapeutic use*; D012965:Sodium Chloride / Q000494:pharmacology / Q000627:therapeutic use*; D013318:Stroke Volume / Q000187:drug effects; D034421:Sus scrofa; D000077585:Terlipressin
chemical_list: D000418:Albumins; D012462:Saline Solution, Hypertonic; D002245:Carbon Dioxide; D012965:Sodium Chloride; D008236:Lypressin; D000077585:Terlipressin; D010100:Oxygen