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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.
J Surg Res. 2006 Nov; 136(1):98-105.JS

Abstract

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+Show Affiliations

Department of Anesthesiology, UNESP - University of São Paulo State, Medical School of Botucatu, Botucatu/SP, Brazil. pnasc@fmb.unesp.brNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

16815449

Citation

Nascimento, Paulo, et al. "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." The Journal of Surgical Research, vol. 136, no. 1, 2006, pp. 98-105.
Nascimento P, de Paiva Filho O, de Carvalho LR, et al. 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. J Surg Res. 2006;136(1):98-105.
Nascimento, P., de Paiva Filho, O., de Carvalho, L. R., & Braz, J. R. (2006). 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. The Journal of Surgical Research, 136(1), 98-105.
Nascimento P, et al. 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. J Surg Res. 2006;136(1):98-105. PubMed PMID: 16815449.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - 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. AU - Nascimento,Paulo,Jr AU - de Paiva Filho,Odilar, AU - de Carvalho,Lídia Raquel, AU - Braz,José Reinaldo Cerqueira, Y1 - 2006/06/30/ PY - 2006/02/17/received PY - 2006/04/17/revised PY - 2006/04/21/accepted PY - 2006/7/4/pubmed PY - 2006/12/15/medline PY - 2006/7/4/entrez SP - 98 EP - 105 JF - The Journal of surgical research JO - J Surg Res VL - 136 IS - 1 N2 - 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. SN - 0022-4804 UR - https://www.unboundmedicine.com/medline/citation/16815449/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_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0022-4804(06)00200-9 DB - PRIME DP - Unbound Medicine ER -