Document Detail


Early hemodynamic and renal effects of hemorrhagic shock resuscitation with lactated Ringer's solution, hydroxyethyl starch, and hypertonic saline with or without 6% dextran-70.
MedLine Citation:
PMID:  16815449     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Considering the renal effects of fluid resuscitation in hemorrhaged patients, the choice of fluid has been a source of controversy. In a model of hemorrhagic shock, we studied the early hemodynamic and renal effects of fluid resuscitation with lactated Ringer's (LR), 6% hydroxyethyl starch (HES), and 7.5% hypertonic saline (HS) with or without 6% dextran-70 (HSD). MATERIALS AND METHODS: Forty-eight dogs were anesthetized and submitted to splenectomy. An estimated 40% blood volume was removed to maintain mean arterial pressure (MAP) at 40 mm Hg for 30 min. The dogs were divided into four groups: LR, in a 3:1 ratio to removed blood volume; HS, 6 mL kg(-1); HSD, 6 mL kg(-1); and HES in a 1:1 ratio to removed blood volume. Hemodynamics and renal function were studied during shock and 5, 60, and 120 min after fluid replacement. RESULTS: Shock treatment increased MAP similarly in all groups. At 5 min, cardiac filling pressures and cardiac performance indexes were higher for LR and HES but, after 120 min, there were no differences among groups. Renal blood flow and glomerular filtration rate (GFR) were higher in LR at 60 min but GFR returned to baseline values in all groups at 120 min. Diuresis was higher for LR at 5 min and for LR and HES at 60 min. There were no differences among groups in renal variables 120 min after treatment. CONCLUSIONS: Despite the immediate differences in hemodynamic responses, the low-volume resuscitation fluids, HS and HSD, are equally effective to LR and HES in restoring renal performance 120 min after hemorrhagic shock treatment.
Authors:
Paulo Nascimento; Odilar de Paiva Filho; Lídia Raquel de Carvalho; José Reinaldo Cerqueira Braz
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Publication Detail:
Type:  Comparative Study; Journal Article     Date:  2006-06-30
Journal Detail:
Title:  The Journal of surgical research     Volume:  136     ISSN:  0022-4804     ISO Abbreviation:  J. Surg. Res.     Publication Date:  2006 Nov 
Date Detail:
Created Date:  2006-10-30     Completed Date:  2006-12-14     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0376340     Medline TA:  J Surg Res     Country:  United States    
Other Details:
Languages:  eng     Pagination:  98-105     Citation Subset:  IM    
Affiliation:
Department of Anesthesiology, UNESP - University of São Paulo State, Medical School of Botucatu, Botucatu/SP, Brazil. pnasc@fmb.unesp.br
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MeSH Terms
Descriptor/Qualifier:
Anesthesia
Animals
Blood Pressure
Dextrans / pharmacology
Disease Models, Animal
Dogs
Female
Fluid Therapy / methods
Hetastarch / pharmacology*
Isotonic Solutions / pharmacology*
Kidney / blood supply,  physiology
Male
Plasma Substitutes / pharmacology*
Pulmonary Wedge Pressure
Resuscitation / methods*
Saline Solution, Hypertonic / pharmacology
Shock, Hemorrhagic / therapy*
Vascular Resistance
Ventricular Pressure
Chemical
Reg. No./Substance:
0/Isotonic Solutions; 0/Plasma Substitutes; 0/Saline Solution, Hypertonic; 8022-63-7/Ringer's lactate; 9004-54-0/Dextrans; 9005-27-0/Hetastarch

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