title: Vasopressin Infusion with Small-Volume Fluid Resuscitation during Hemorrhagic Shock Promotes Hemodynamic Stability and Survival in Swine.
abstract: BACKGROUND
  Current management of hemorrhagic shock (HS) in the battlefield and civilian settings favors small-volume fluid resuscitation before controlling the source of bleeding. We investigated in a swine model of HS the effects of vasopressin infusion along with small-volume fluid resuscitation; with erythropoietin (EPO) and HS severity as additional factors.
  
  
  METHODS
  HS was induced in 24 male domestic pigs (36 to 41 kg) by blood withdrawal (BW) through a right atrial cannula modeling spontaneous bleeding by a mono-exponential decay function. The initial 12 pigs received no fluids; the last 12 pigs received normal saline (NS) half the BW volume. Pigs were randomized 2:1 to receive intraosseously vasopressin (0.04 U/kg·min-1) or vehicle control from minute 7 to minute 210. Pigs assigned to vasopressin were further randomized 1:1 to receive EPO (1,200 U/kg) or vehicle control and 1:1 to have 65% or 75% BW of their blood volume. Shed blood was reinfused at 210 minutes and the pigs recovered from anesthesia.
  
  
  RESULTS
  Survival at 72 hours was influenced by vasopressin and NS but not by EPO or % BW. Vasopressin with NS promoted the highest survival (8/8) followed by vasopressin without NS (3/8), NS without vasopressin (1/4), and neither treatment (0/4) with overall statistical significance (log-rank test, p = 0.009) and each subset different from vasopressin with NS by Holm-Sidak test. Vasopressin increased systemic vascular resistance whereas NS increased cardiac output.
  
  
  CONCLUSIONS
  Vasopressin infusion with small-volume fluid resuscitation during severe HS was highly effective enabling critical hemodynamic stabilization and improved 72 hour survival.
authors.affiliation: Department of Medicine and Resuscitation Institute at Rosalind Franklin University of Medicine and Science, North Chicago, IL, United States of America; Department of Physiology at Rosalind Franklin University of Medicine and Science, North Chicago, IL, United States of America; Critical Care Medicine at Captain James A. Lovell Federal Health Care Center, North Chicago, IL, United States of America.
authors.forename: Raúl J
authors.initials: RJ
authors.lastname: Gazmuri
authors.affiliation: Department of Medicine and Resuscitation Institute at Rosalind Franklin University of Medicine and Science, North Chicago, IL, United States of America.
authors.forename: Kasen
authors.initials: K
authors.lastname: Whitehouse
authors.affiliation: Department of Medicine and Resuscitation Institute at Rosalind Franklin University of Medicine and Science, North Chicago, IL, United States of America.
authors.forename: Karla
authors.initials: K
authors.lastname: Whittinghill
authors.affiliation: Department of Medicine and Resuscitation Institute at Rosalind Franklin University of Medicine and Science, North Chicago, IL, United States of America.
authors.forename: Alvin
authors.initials: A
authors.lastname: Baetiong
authors.affiliation: Department of Medicine and Resuscitation Institute at Rosalind Franklin University of Medicine and Science, North Chicago, IL, United States of America.
authors.forename: Jeejabai
authors.initials: J
authors.lastname: Radhakrishnan
mesh_terms: D000818:Animals; D004921:Erythropoietin / Q000008:administration & dosage; D005440:Fluid Therapy; D006439:Hemodynamics; D008297:Male; D012771:Shock, Hemorrhagic / Q000188:drug therapy*; D013552:Swine; D014667:Vasopressins / Q000008:administration & dosage*
chemical_list: D014667:Vasopressins; D004921:Erythropoietin