Lactated Ringer's is superior to normal saline in the resuscitation of uncontrolled hemorrhagic shock

S. Rob Todd, Darren Malinoski, Patrick J. Muller, Martin Schreiber

    Research output: Contribution to journalArticle

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    Abstract

    BACKGROUND: Normal saline (NS) and lactated Ringer's solution (LR) continue to be used interchangeably for the resuscitation of hemorrhagic shock in some institutions. We hypothesized that, aside from hyperchloremic acidosis, NS resuscitation would be similar to that of LR in a swine model of uncontrolled hemorrhage. METHODS: Twenty swine weighing a mean of 37 kg underwent invasive line placement, midline celiotomy, and splenectomy. After a 15-minute stabilization period, we recorded a baseline mean arterial pressure (MAP) and created a grade V liver injury. The animals bled freely for 30 minutes after which we measured blood loss. We blindly randomized the swine to receive NS (10 animals) versus LR (10 animals) to achieve and maintain the baseline MAP for 90 minutes postinjury. Laboratory values were obtained at baseline and upon completion of the 2-hour study period. RESULTS: Initial blood loss was 25 mL/kg in the NS group and 22 mL/kg in the LR group (p = 0.54). Animals required 256.3 ± 145.4 mL/kg of fluid in the NS group as compared with 125.7 ± 67.3 mL/kg in the LR group (p = 0.04). The urine output was higher in the NS group (46.6 ± 39.5 mL/kg versus 18.9 ± 12.9 mL/kg, p = 0.04). Upon study completion, the NS group had a significant hyperchloremia (119 ± 1.9 mEq/L versus 105 ± 2.9 mEq/L, p <0.01) with acidosis (7.28 ± 0.12 versus 7.45 ± 0.06, p <0.01) in comparison to the LR group. In addition, resuscitation with NS resulted in significantly lower fibrinogen levels (99 ± 21 mg/dL versus 123 ± 20 mg/dL, p = 0.02). The serum lactate was 4.7 ± 2.2 in the LR group and 1.7 ± 1.7 in the NS swine (p <0.01) at the end of the study. CONCLUSIONS: Resuscitation of uncontrolled hemorrhagic shock with NS requires significantly greater volume and is associated with greater urine output, hyperchloremic acidosis, and dilutional coagulopathy as compared with LR. Resuscitation with LR results in an elevation of the lactate level that is not associated with acidosis. Lactated Ringer's solution is superior to NS for the resuscitation of uncontrolled hemorrhagic shock in swine.

    Original languageEnglish (US)
    Pages (from-to)636-639
    Number of pages4
    JournalJournal of Trauma - Injury, Infection and Critical Care
    Volume62
    Issue number3
    DOIs
    StatePublished - Mar 2007

    Fingerprint

    Hemorrhagic Shock
    Resuscitation
    Acidosis
    Swine
    Lactic Acid
    Arterial Pressure
    Ringer's lactate
    Ringer's solution
    Urine
    Splenectomy
    Fibrinogen
    Hemorrhage

    Keywords

    • Hemorrhagic shock
    • Lactated Ringer's
    • Normal saline
    • Resuscitation
    • Trauma

    ASJC Scopus subject areas

    • Surgery

    Cite this

    Lactated Ringer's is superior to normal saline in the resuscitation of uncontrolled hemorrhagic shock. / Todd, S. Rob; Malinoski, Darren; Muller, Patrick J.; Schreiber, Martin.

    In: Journal of Trauma - Injury, Infection and Critical Care, Vol. 62, No. 3, 03.2007, p. 636-639.

    Research output: Contribution to journalArticle

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    abstract = "BACKGROUND: Normal saline (NS) and lactated Ringer's solution (LR) continue to be used interchangeably for the resuscitation of hemorrhagic shock in some institutions. We hypothesized that, aside from hyperchloremic acidosis, NS resuscitation would be similar to that of LR in a swine model of uncontrolled hemorrhage. METHODS: Twenty swine weighing a mean of 37 kg underwent invasive line placement, midline celiotomy, and splenectomy. After a 15-minute stabilization period, we recorded a baseline mean arterial pressure (MAP) and created a grade V liver injury. The animals bled freely for 30 minutes after which we measured blood loss. We blindly randomized the swine to receive NS (10 animals) versus LR (10 animals) to achieve and maintain the baseline MAP for 90 minutes postinjury. Laboratory values were obtained at baseline and upon completion of the 2-hour study period. RESULTS: Initial blood loss was 25 mL/kg in the NS group and 22 mL/kg in the LR group (p = 0.54). Animals required 256.3 ± 145.4 mL/kg of fluid in the NS group as compared with 125.7 ± 67.3 mL/kg in the LR group (p = 0.04). The urine output was higher in the NS group (46.6 ± 39.5 mL/kg versus 18.9 ± 12.9 mL/kg, p = 0.04). Upon study completion, the NS group had a significant hyperchloremia (119 ± 1.9 mEq/L versus 105 ± 2.9 mEq/L, p <0.01) with acidosis (7.28 ± 0.12 versus 7.45 ± 0.06, p <0.01) in comparison to the LR group. In addition, resuscitation with NS resulted in significantly lower fibrinogen levels (99 ± 21 mg/dL versus 123 ± 20 mg/dL, p = 0.02). The serum lactate was 4.7 ± 2.2 in the LR group and 1.7 ± 1.7 in the NS swine (p <0.01) at the end of the study. CONCLUSIONS: Resuscitation of uncontrolled hemorrhagic shock with NS requires significantly greater volume and is associated with greater urine output, hyperchloremic acidosis, and dilutional coagulopathy as compared with LR. Resuscitation with LR results in an elevation of the lactate level that is not associated with acidosis. Lactated Ringer's solution is superior to NS for the resuscitation of uncontrolled hemorrhagic shock in swine.",
    keywords = "Hemorrhagic shock, Lactated Ringer's, Normal saline, Resuscitation, Trauma",
    author = "Todd, {S. Rob} and Darren Malinoski and Muller, {Patrick J.} and Martin Schreiber",
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    T1 - Lactated Ringer's is superior to normal saline in the resuscitation of uncontrolled hemorrhagic shock

    AU - Todd, S. Rob

    AU - Malinoski, Darren

    AU - Muller, Patrick J.

    AU - Schreiber, Martin

    PY - 2007/3

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    N2 - BACKGROUND: Normal saline (NS) and lactated Ringer's solution (LR) continue to be used interchangeably for the resuscitation of hemorrhagic shock in some institutions. We hypothesized that, aside from hyperchloremic acidosis, NS resuscitation would be similar to that of LR in a swine model of uncontrolled hemorrhage. METHODS: Twenty swine weighing a mean of 37 kg underwent invasive line placement, midline celiotomy, and splenectomy. After a 15-minute stabilization period, we recorded a baseline mean arterial pressure (MAP) and created a grade V liver injury. The animals bled freely for 30 minutes after which we measured blood loss. We blindly randomized the swine to receive NS (10 animals) versus LR (10 animals) to achieve and maintain the baseline MAP for 90 minutes postinjury. Laboratory values were obtained at baseline and upon completion of the 2-hour study period. RESULTS: Initial blood loss was 25 mL/kg in the NS group and 22 mL/kg in the LR group (p = 0.54). Animals required 256.3 ± 145.4 mL/kg of fluid in the NS group as compared with 125.7 ± 67.3 mL/kg in the LR group (p = 0.04). The urine output was higher in the NS group (46.6 ± 39.5 mL/kg versus 18.9 ± 12.9 mL/kg, p = 0.04). Upon study completion, the NS group had a significant hyperchloremia (119 ± 1.9 mEq/L versus 105 ± 2.9 mEq/L, p <0.01) with acidosis (7.28 ± 0.12 versus 7.45 ± 0.06, p <0.01) in comparison to the LR group. In addition, resuscitation with NS resulted in significantly lower fibrinogen levels (99 ± 21 mg/dL versus 123 ± 20 mg/dL, p = 0.02). The serum lactate was 4.7 ± 2.2 in the LR group and 1.7 ± 1.7 in the NS swine (p <0.01) at the end of the study. CONCLUSIONS: Resuscitation of uncontrolled hemorrhagic shock with NS requires significantly greater volume and is associated with greater urine output, hyperchloremic acidosis, and dilutional coagulopathy as compared with LR. Resuscitation with LR results in an elevation of the lactate level that is not associated with acidosis. Lactated Ringer's solution is superior to NS for the resuscitation of uncontrolled hemorrhagic shock in swine.

    AB - BACKGROUND: Normal saline (NS) and lactated Ringer's solution (LR) continue to be used interchangeably for the resuscitation of hemorrhagic shock in some institutions. We hypothesized that, aside from hyperchloremic acidosis, NS resuscitation would be similar to that of LR in a swine model of uncontrolled hemorrhage. METHODS: Twenty swine weighing a mean of 37 kg underwent invasive line placement, midline celiotomy, and splenectomy. After a 15-minute stabilization period, we recorded a baseline mean arterial pressure (MAP) and created a grade V liver injury. The animals bled freely for 30 minutes after which we measured blood loss. We blindly randomized the swine to receive NS (10 animals) versus LR (10 animals) to achieve and maintain the baseline MAP for 90 minutes postinjury. Laboratory values were obtained at baseline and upon completion of the 2-hour study period. RESULTS: Initial blood loss was 25 mL/kg in the NS group and 22 mL/kg in the LR group (p = 0.54). Animals required 256.3 ± 145.4 mL/kg of fluid in the NS group as compared with 125.7 ± 67.3 mL/kg in the LR group (p = 0.04). The urine output was higher in the NS group (46.6 ± 39.5 mL/kg versus 18.9 ± 12.9 mL/kg, p = 0.04). Upon study completion, the NS group had a significant hyperchloremia (119 ± 1.9 mEq/L versus 105 ± 2.9 mEq/L, p <0.01) with acidosis (7.28 ± 0.12 versus 7.45 ± 0.06, p <0.01) in comparison to the LR group. In addition, resuscitation with NS resulted in significantly lower fibrinogen levels (99 ± 21 mg/dL versus 123 ± 20 mg/dL, p = 0.02). The serum lactate was 4.7 ± 2.2 in the LR group and 1.7 ± 1.7 in the NS swine (p <0.01) at the end of the study. CONCLUSIONS: Resuscitation of uncontrolled hemorrhagic shock with NS requires significantly greater volume and is associated with greater urine output, hyperchloremic acidosis, and dilutional coagulopathy as compared with LR. Resuscitation with LR results in an elevation of the lactate level that is not associated with acidosis. Lactated Ringer's solution is superior to NS for the resuscitation of uncontrolled hemorrhagic shock in swine.

    KW - Hemorrhagic shock

    KW - Lactated Ringer's

    KW - Normal saline

    KW - Resuscitation

    KW - Trauma

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