Aggressive treatment of acute kidney injury and hyperkalemia improves survival in a combat relevant trauma model in swine

Sawyer Smith, Brandon Behrens, Belinda McCully, James Murphy, Aravind Bommiasamy, Andrew Goodman, Elizabeth Dewey, Shibani Pati, Martin Schreiber

Research output: Contribution to journalArticlepeer-review

1 Scopus citations

Abstract

Introduction: Our swine model of pulmonary contusion (PC) and hemorrhagic shock (HS) was initially complicated by renal failure, hyperkalemia, and premature death. To study the effects of novel therapies on organ failure, improved survival was necessary requiring the design of an aggressive treatment regimen. Methods: Anesthetized swine sustained either PC or PC with grade V liver injury to induce HS (PC + HS). After injury, animals were resuscitated followed by either standard care (SC) with maintenance intravenous fluids (IVF) and treatment at potassium level of 6.0 mmol/L (n = 7; 3 PC, 4 PC + HS) or aggressive care (AC) with increased initial IVF, early and frequent potassium monitoring, and treatment at potassium level of 5.0 mmol/L (n = 15, 8 PC, 7 PC + HS). Hyperkalemia was treated with calcium, insulin, and glucose in both groups. Results: Survival to 48 h was achieved in 13/15 (87%) in the AC group and 2/7 (29%) in the SC group (p = 0.014). Compared to SC, AC improved median survival (48 vs. 18 h, p = 0.008) and lowered potassium (5.0 vs. 7.5 mmol/L), creatinine (2.4 vs. 4.0 mg/dL), BUN (27.5 vs. 39.0 mg/dL), and lactate (0.97 vs. 3.57 mmol/L) at the last observed time-point prior to death. For PC + HS animals, survival to 48 h was achieved in 6/7 in the AC group and 0/4 in the SC group with an improved median survival in the AC group (48 vs. 18 h, p = 0.011) Discussion: Aggressive and early hyperkalemia treatment prolongs survival while reducing kidney injury and potassium levels in a combat relevant injury model in swine.

Original languageEnglish (US)
Pages (from-to)860-864
Number of pages5
JournalAmerican journal of surgery
Volume219
Issue number5
DOIs
StatePublished - May 2020

Keywords

  • Hyperkalemia
  • Swine model
  • Trauma

ASJC Scopus subject areas

  • Surgery

Fingerprint Dive into the research topics of 'Aggressive treatment of acute kidney injury and hyperkalemia improves survival in a combat relevant trauma model in swine'. Together they form a unique fingerprint.

Cite this