A single bolus of 3% hypertonic saline with 6% dextran provides optimal initial resuscitation after uncontrolled hemorrhagic shock

Jennifer Watters, Brandon Tieu, Jerome A. Differding, Patrick J. Muller, Martin Schreiber

Research output: Contribution to journalArticle

44 Citations (Scopus)

Abstract

BACKGROUND: The optimal fluid for early resuscitation of hemorrhagic shock would restore perfusion without increasing blood loss, hypothermia, acidosis, or coagulopathy. This study examined effects of a single bolus of hypertonic saline (HTS) with or without (±) dextran (D) after uncontrolled hemorrhage (UH) and determined optimal fluid composition. METHODS: Fifty swine were anesthetized and underwent invasive line placement, celiotomy, splenectomy, suprapubic catheterization, and grade V liver injury. After 30 minutes of UH, blinded fluid resuscitation was initiated with a 250-mL bolus. Animals were randomized to five groups: normal saline (NS), 3% HTS (3%), 3% HTS/6% D (3% D), 7.5% HTS (7.5%), or 7.5% HTS/6% D (7.5% D). Mean arterial pressure (MAP) and tissue oxygen saturation (StO2) were recorded. Laboratory and thrombelastography (TEG) data were collected every 30 minutes. Animals were sacrificed 120 minutes after injury. Analysis of variance was used to compare groups. Significance was defined as p <0.05. RESULTS: Baseline characteristics and laboratory values were similar in all groups. All groups achieved a similar degree of shock. Two NS and two 3% animals did not survive to 120 minutes. Fluids containing dextran produced a significantly greater increase in MAP (p <0.02). Animals receiving 3% D maintained a higher MAP 90 minutes after fluid bolus. Also, 7.5% ± D produced a significantly greater initial increase in StO2 (p <0.05). This effect declined after fluid bolus while 3% D continued to improve tissue oxygenation. Significant differences developed between groups in TEG values, hematocrit, fibrinogen, urine sodium, serum sodium, serum chloride, and urine output. CONCLUSIONS: A single bolus of 3% D after uncontrolled hemorrhagic shock produces an adequate and sustained rise in MAP and StO2 and attenuates hypercoagulability. Resuscitation with 7.5% ± D produces significantly increased urine output accompanied by a decline in MAP and StO2 over time. A single bolus of 7.5% D results in significant dilutional anemia and relative hypofibrinogenemia.

Original languageEnglish (US)
Pages (from-to)75-81
Number of pages7
JournalJournal of Trauma - Injury, Infection and Critical Care
Volume61
Issue number1
DOIs
StatePublished - Jul 2006

Fingerprint

Hemorrhagic Shock
Dextrans
Resuscitation
Arterial Pressure
Thrombelastography
Urine
Hemorrhage
Thrombophilia
Wounds and Injuries
Splenectomy
Acidosis
Hypothermia
Serum
Hematocrit
Sodium Chloride
Catheterization
Fibrinogen
Anemia
Shock
Analysis of Variance

Keywords

  • Dextran
  • Hemorrhagic shock
  • Hypertonic saline
  • Resuscitation

ASJC Scopus subject areas

  • Surgery

Cite this

@article{fe22b51c5dee4f418cd0919e78212781,
title = "A single bolus of 3{\%} hypertonic saline with 6{\%} dextran provides optimal initial resuscitation after uncontrolled hemorrhagic shock",
abstract = "BACKGROUND: The optimal fluid for early resuscitation of hemorrhagic shock would restore perfusion without increasing blood loss, hypothermia, acidosis, or coagulopathy. This study examined effects of a single bolus of hypertonic saline (HTS) with or without (±) dextran (D) after uncontrolled hemorrhage (UH) and determined optimal fluid composition. METHODS: Fifty swine were anesthetized and underwent invasive line placement, celiotomy, splenectomy, suprapubic catheterization, and grade V liver injury. After 30 minutes of UH, blinded fluid resuscitation was initiated with a 250-mL bolus. Animals were randomized to five groups: normal saline (NS), 3{\%} HTS (3{\%}), 3{\%} HTS/6{\%} D (3{\%} D), 7.5{\%} HTS (7.5{\%}), or 7.5{\%} HTS/6{\%} D (7.5{\%} D). Mean arterial pressure (MAP) and tissue oxygen saturation (StO2) were recorded. Laboratory and thrombelastography (TEG) data were collected every 30 minutes. Animals were sacrificed 120 minutes after injury. Analysis of variance was used to compare groups. Significance was defined as p <0.05. RESULTS: Baseline characteristics and laboratory values were similar in all groups. All groups achieved a similar degree of shock. Two NS and two 3{\%} animals did not survive to 120 minutes. Fluids containing dextran produced a significantly greater increase in MAP (p <0.02). Animals receiving 3{\%} D maintained a higher MAP 90 minutes after fluid bolus. Also, 7.5{\%} ± D produced a significantly greater initial increase in StO2 (p <0.05). This effect declined after fluid bolus while 3{\%} D continued to improve tissue oxygenation. Significant differences developed between groups in TEG values, hematocrit, fibrinogen, urine sodium, serum sodium, serum chloride, and urine output. CONCLUSIONS: A single bolus of 3{\%} D after uncontrolled hemorrhagic shock produces an adequate and sustained rise in MAP and StO2 and attenuates hypercoagulability. Resuscitation with 7.5{\%} ± D produces significantly increased urine output accompanied by a decline in MAP and StO2 over time. A single bolus of 7.5{\%} D results in significant dilutional anemia and relative hypofibrinogenemia.",
keywords = "Dextran, Hemorrhagic shock, Hypertonic saline, Resuscitation",
author = "Jennifer Watters and Brandon Tieu and Differding, {Jerome A.} and Muller, {Patrick J.} and Martin Schreiber",
year = "2006",
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doi = "10.1097/01.ta.0000222723.54559.47",
language = "English (US)",
volume = "61",
pages = "75--81",
journal = "Journal of Trauma and Acute Care Surgery",
issn = "2163-0755",
publisher = "Lippincott Williams and Wilkins",
number = "1",

}

TY - JOUR

T1 - A single bolus of 3% hypertonic saline with 6% dextran provides optimal initial resuscitation after uncontrolled hemorrhagic shock

AU - Watters, Jennifer

AU - Tieu, Brandon

AU - Differding, Jerome A.

AU - Muller, Patrick J.

AU - Schreiber, Martin

PY - 2006/7

Y1 - 2006/7

N2 - BACKGROUND: The optimal fluid for early resuscitation of hemorrhagic shock would restore perfusion without increasing blood loss, hypothermia, acidosis, or coagulopathy. This study examined effects of a single bolus of hypertonic saline (HTS) with or without (±) dextran (D) after uncontrolled hemorrhage (UH) and determined optimal fluid composition. METHODS: Fifty swine were anesthetized and underwent invasive line placement, celiotomy, splenectomy, suprapubic catheterization, and grade V liver injury. After 30 minutes of UH, blinded fluid resuscitation was initiated with a 250-mL bolus. Animals were randomized to five groups: normal saline (NS), 3% HTS (3%), 3% HTS/6% D (3% D), 7.5% HTS (7.5%), or 7.5% HTS/6% D (7.5% D). Mean arterial pressure (MAP) and tissue oxygen saturation (StO2) were recorded. Laboratory and thrombelastography (TEG) data were collected every 30 minutes. Animals were sacrificed 120 minutes after injury. Analysis of variance was used to compare groups. Significance was defined as p <0.05. RESULTS: Baseline characteristics and laboratory values were similar in all groups. All groups achieved a similar degree of shock. Two NS and two 3% animals did not survive to 120 minutes. Fluids containing dextran produced a significantly greater increase in MAP (p <0.02). Animals receiving 3% D maintained a higher MAP 90 minutes after fluid bolus. Also, 7.5% ± D produced a significantly greater initial increase in StO2 (p <0.05). This effect declined after fluid bolus while 3% D continued to improve tissue oxygenation. Significant differences developed between groups in TEG values, hematocrit, fibrinogen, urine sodium, serum sodium, serum chloride, and urine output. CONCLUSIONS: A single bolus of 3% D after uncontrolled hemorrhagic shock produces an adequate and sustained rise in MAP and StO2 and attenuates hypercoagulability. Resuscitation with 7.5% ± D produces significantly increased urine output accompanied by a decline in MAP and StO2 over time. A single bolus of 7.5% D results in significant dilutional anemia and relative hypofibrinogenemia.

AB - BACKGROUND: The optimal fluid for early resuscitation of hemorrhagic shock would restore perfusion without increasing blood loss, hypothermia, acidosis, or coagulopathy. This study examined effects of a single bolus of hypertonic saline (HTS) with or without (±) dextran (D) after uncontrolled hemorrhage (UH) and determined optimal fluid composition. METHODS: Fifty swine were anesthetized and underwent invasive line placement, celiotomy, splenectomy, suprapubic catheterization, and grade V liver injury. After 30 minutes of UH, blinded fluid resuscitation was initiated with a 250-mL bolus. Animals were randomized to five groups: normal saline (NS), 3% HTS (3%), 3% HTS/6% D (3% D), 7.5% HTS (7.5%), or 7.5% HTS/6% D (7.5% D). Mean arterial pressure (MAP) and tissue oxygen saturation (StO2) were recorded. Laboratory and thrombelastography (TEG) data were collected every 30 minutes. Animals were sacrificed 120 minutes after injury. Analysis of variance was used to compare groups. Significance was defined as p <0.05. RESULTS: Baseline characteristics and laboratory values were similar in all groups. All groups achieved a similar degree of shock. Two NS and two 3% animals did not survive to 120 minutes. Fluids containing dextran produced a significantly greater increase in MAP (p <0.02). Animals receiving 3% D maintained a higher MAP 90 minutes after fluid bolus. Also, 7.5% ± D produced a significantly greater initial increase in StO2 (p <0.05). This effect declined after fluid bolus while 3% D continued to improve tissue oxygenation. Significant differences developed between groups in TEG values, hematocrit, fibrinogen, urine sodium, serum sodium, serum chloride, and urine output. CONCLUSIONS: A single bolus of 3% D after uncontrolled hemorrhagic shock produces an adequate and sustained rise in MAP and StO2 and attenuates hypercoagulability. Resuscitation with 7.5% ± D produces significantly increased urine output accompanied by a decline in MAP and StO2 over time. A single bolus of 7.5% D results in significant dilutional anemia and relative hypofibrinogenemia.

KW - Dextran

KW - Hemorrhagic shock

KW - Hypertonic saline

KW - Resuscitation

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