Document Detail


Arginine vasopressin, but not epinephrine, improves survival in uncontrolled hemorrhagic shock after liver trauma in pigs.
MedLine Citation:
PMID:  12682488     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: Epinephrine is widely used for treatment of life-threatening hypotension, although new vasopressor drugs may merit evaluation. The purpose of this study was to determine the effects of vasopressin vs. epinephrine vs. saline placebo on hemodynamic variables, regional blood flow, and short-term survival in an animal model of uncontrolled hemorrhagic shock and delayed fluid resuscitation. DESIGN: Prospective, randomized, laboratory investigation that used a porcine model for measurement of hemodynamic variables and regional abdominal organ blood flow. SETTING: University hospital laboratory. SUBJECTS: A total of 21 pigs weighing 32 +/- 3 kg. INTERVENTIONS: The anesthetized pigs were subjected to a penetrating liver injury, which resulted in a mean +/- sem loss of 40% +/- 5% of estimated whole blood volume within 30 mins and mean arterial pressures of <20 mm Hg. When heart rate declined progressively, pigs randomly received a bolus dose and continuous infusion of either vasopressin (0.4 units/kg and 0.04 units.kg-1.min-1, n = 7), or epinephrine (45 microg/kg and 5 microg.kg(-1).min(-1), n = 7), or an equal volume of saline placebo (n = 7), respectively. At 30 mins after drug administration, all surviving animals were fluid resuscitated while bleeding was surgically controlled. MEASUREMENTS AND MAIN RESULTS: Mean +/- sem arterial blood pressure at 2.5 and 10 mins was significantly (p <.001) higher after vasopressin vs. epinephrine vs. saline placebo (82 +/- 14 vs. 23 +/- 4 vs. 11 +/- 3 mm Hg, and 42 +/- 4 vs. 10 +/- 5 vs. 6 +/- 3 mm Hg, respectively). Although portal vein blood flow was temporarily impaired by vasopressin, it was subsequently restored and significantly (p <.01) higher when compared with epinephrine or saline placebo (9 +/- 5 vs. 121 +/- 3 vs. 54 +/- 22 mL/min and 150 +/- 20 vs. 31 +/- 17 vs. 0 +/- 0 mL/min, respectively). Hepatic and renal artery blood flow was significantly higher throughout the study in the vasopressin group; however, no further bleeding was observed. Despite a second bolus dose, all epinephrine- and saline placebo-treated animals died within 15 mins after drug administration. By contrast, seven of seven vasopressin-treated animals survived until fluid replacement, and 60 mins thereafter, without further vasopressor therapy (p <.01). Moreover, blood flow to liver, gut, and kidney returned to normal values in the postshock phase. CONCLUSIONS: Vasopressin, but not epinephrine or saline placebo, improved short-term survival in a porcine model of uncontrolled hemorrhagic shock after liver injury when surgical intervention and fluid replacement was delayed.
Authors:
Wolfgang G Voelckel; Claus Raedler; Volker Wenzel; Karl H Lindner; Anette C Krismer; Christian A Schmittinger; Holger Herff; Klaus Rheinberger; Alfred Königsrainer
Related Documents :
21138818 - Determination of venous blood flow velocity using digital videomicroscopy (a short meth...
19280548 - Peripheral intravenous power injection of iodinated contrast media through 22g and 20g ...
14518768 - Development of asymmetrical flow field-flow fractionation-multi angle laser light scatt...
2856188 - Antithrombotic effects of the thromboxane a2 antagonist, sq 28,668, in vitro and in the...
15922898 - Autologous blood donation.
3722958 - Influence of the increased uterine tonus on maternal hemodynamics.
Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Critical care medicine     Volume:  31     ISSN:  0090-3493     ISO Abbreviation:  Crit. Care Med.     Publication Date:  2003 Apr 
Date Detail:
Created Date:  2003-04-08     Completed Date:  2003-05-01     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  0355501     Medline TA:  Crit Care Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1160-5     Citation Subset:  AIM; IM    
Affiliation:
Departments of Anesthesiology and Critical Care Medicine, Leopold-Franzens-University, Innsbruck, Austria.
Export Citation:
APA/MLA Format     Download EndNote     Download BibTex
MeSH Terms
Descriptor/Qualifier:
Animals
Arginine Vasopressin / therapeutic use*
Blood Flow Velocity
Epinephrine / therapeutic use*
Heart Rate
Hepatic Artery
Liver / injuries*
Portal Vein
Renal Artery
Resuscitation
Shock, Hemorrhagic / drug therapy*,  mortality,  physiopathology,  therapy
Survival Rate
Swine
Vasoconstrictor Agents / therapeutic use*
Chemical
Reg. No./Substance:
0/Vasoconstrictor Agents; 113-79-1/Arginine Vasopressin; 51-43-4/Epinephrine
Comments/Corrections
Comment In:
Crit Care Med. 2003 Apr;31(4):1286-7   [PMID:  12682512 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


Previous Document:  Chronic Staphylococcal enterotoxin B and lipopolysaccharide induce a bimodal pattern of hepatic dysf...
Next Document:  Effects of exogenous surfactant supplementation and partial liquid ventilation on acute lung injury ...