Document Detail

Fluid Resuscitation Guided by Sublingual Partial Pressure of Carbon Dioxide during Hemorrhagic Shock in a Porcine Model.
MedLine Citation:
PMID:  23364438     Owner:  NLM     Status:  Publisher    
ABSTRACT: To avoid aggressive fluid resuscitation during hemorrhagic shock, fluid resuscitation is best guided by a specific measurement of tissue perfusion. We investigated whether fluid resuscitation guided by sublingual PCO2 would reduce the amount of resuscitation fluid without compromising the outcomes of hemorrhagic shock.Ten male domestic pigs weighing between 34-37 kg were utilized. Forty-five percent of estimated blood volume was removed over an interval of 1 h. The animals were then randomized to receive fluid resuscitation based on either sublingual PCO2 or blood pressure. In the sublingual PCO2 guided group, resuscitation was initiated when sublingual PCO2 exceeded 70 Torr and stopped when it decreased to 50 Torr. In the blood pressure guided group, resuscitation was initiated when mean aortic pressure decreased to 60 mm Hg and stopped when it increased to 90 mm Hg. First, ringer's lactate solution of 30 ml/kg was administrated; subsequently, the shed blood was transfused if sublingual PCO2 remained greater than 50 Torr in the sublingual PCO2 guided group or mean aortic pressure was less than 90 mmHg in the blood pressure guided group. All the animals were monitored for 4 h and observed for an additional 68 h.In the sublingual PCO2 guided group, fluid resuscitation was required in only 40 % of the animals. In addition, a significantly lower volume of ringer's lactate solution (170±239 ml, P=0.005 vs. blood pressure guided group) was administrated without the need of blood infusion in this group. However, in the blood pressure guided group, all the animals required a significantly larger volume of fluid (955±381 ml) including both ringer's lactate solution and blood. There were no differences in post-resuscitation tissue microcirculation, myocardial and neurologic function and 72 h survival between groups.During hemorrhagic shock, fluid resuscitation guided by sublingual PCO2 significantly reduced the amount of resuscitation fluid without compromising the outcomes of hemorrhagic shock.
Jiefeng Xu; Linhao Ma; Shijie Sun; Xiaoye Lu; Xiaobo Wu; Zilong Li; Wanchun Tang
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2013-1-28
Journal Detail:
Title:  Shock (Augusta, Ga.)     Volume:  -     ISSN:  1540-0514     ISO Abbreviation:  Shock     Publication Date:  2013 Jan 
Date Detail:
Created Date:  2013-1-31     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9421564     Medline TA:  Shock     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
1Weil Institute of Critical Care Medicine, Rancho Mirage, CA, USA 2Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA 3The Department of Emergency Medicine, Yuyao People's Hospital, Medical School of Ningbo University, Ningbo, China.
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