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Small volume resuscitation: a randomized controlled trial with either norepinephrine or vasopressin during severe hemorrhage.
J Trauma. 2007 Mar; 62(3):640-6.JT

Abstract

BACKGROUND

The present study was designed to evaluate the effects of hypertonic-hyperoncotic hydroxyethyl starch solution (HHS) combined with either norepinephrine (NE) or arginine vasopressin (AVP) on cerebral perfusion pressure (CPP) and brain metabolism after hemorrhagic shock.

METHODS

Fourteen pigs were subjected to uncontrolled liver bleeding until hemodynamic decompensation followed by resuscitation using HHS (4 mL/kg) combined with either NE (bolus of 1000 microg; 60 microg/kg/hr; n = 7) or AVP (bolus of 10 U; 2 U/kg/hr; n = 7), respectively. Extracellular cerebral concentrations of glucose, glycerol, lactate, and the lactate/pyruvate ratio were assessed by microdialysis. After 30 minutes of therapy, bleeding was controlled by manual compression and all surviving animals were observed for 1 hour.

RESULTS

After hemodynamic decompensation, AVP resulted in a significantly higher increase of CPP (mean +/- SD; 47 +/- 19 versus 28 +/- 9 mm Hg; p < 0.01) and cerebral venous partial pressure of oxygen (66 +/- 8 versus 49 +/- 9 mm Hg; p < 0.05) compared with NE after 10 minutes of therapy. Hemodynamic data and blood gas variables were not different between groups during the remaining study period. Brain metabolism was found comparable in both groups at any time.

CONCLUSIONS

AVP was comparable to NE with respect to hemodynamics and blood gases, as well as brain metabolism in surviving animals throughout the study period. Our findings emphasize the importance of early resuscitation, as neuronal cell damage potentially starts immediately after onset of severe hemorrhage.

Authors+Show Affiliations

Department of Anaesthesiology and Intensive Care Medicine, University Hospital Schleswig-Holstein, Campus Kiel, Germany. meybohm@anaesthesie.uni-kiel.deNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

17414341

Citation

Meybohm, Patrick, et al. "Small Volume Resuscitation: a Randomized Controlled Trial With Either Norepinephrine or Vasopressin During Severe Hemorrhage." The Journal of Trauma, vol. 62, no. 3, 2007, pp. 640-6.
Meybohm P, Cavus E, Bein B, et al. Small volume resuscitation: a randomized controlled trial with either norepinephrine or vasopressin during severe hemorrhage. J Trauma. 2007;62(3):640-6.
Meybohm, P., Cavus, E., Bein, B., Steinfath, M., Weber, B., Hamann, C., Scholz, J., & Dörges, V. (2007). Small volume resuscitation: a randomized controlled trial with either norepinephrine or vasopressin during severe hemorrhage. The Journal of Trauma, 62(3), 640-6.
Meybohm P, et al. Small Volume Resuscitation: a Randomized Controlled Trial With Either Norepinephrine or Vasopressin During Severe Hemorrhage. J Trauma. 2007;62(3):640-6. PubMed PMID: 17414341.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Small volume resuscitation: a randomized controlled trial with either norepinephrine or vasopressin during severe hemorrhage. AU - Meybohm,Patrick, AU - Cavus,Erol, AU - Bein,Berthold, AU - Steinfath,Markus, AU - Weber,Bernd, AU - Hamann,Claudius, AU - Scholz,Jens, AU - Dörges,Volker, PY - 2007/4/7/pubmed PY - 2007/5/2/medline PY - 2007/4/7/entrez SP - 640 EP - 6 JF - The Journal of trauma JO - J Trauma VL - 62 IS - 3 N2 - BACKGROUND: The present study was designed to evaluate the effects of hypertonic-hyperoncotic hydroxyethyl starch solution (HHS) combined with either norepinephrine (NE) or arginine vasopressin (AVP) on cerebral perfusion pressure (CPP) and brain metabolism after hemorrhagic shock. METHODS: Fourteen pigs were subjected to uncontrolled liver bleeding until hemodynamic decompensation followed by resuscitation using HHS (4 mL/kg) combined with either NE (bolus of 1000 microg; 60 microg/kg/hr; n = 7) or AVP (bolus of 10 U; 2 U/kg/hr; n = 7), respectively. Extracellular cerebral concentrations of glucose, glycerol, lactate, and the lactate/pyruvate ratio were assessed by microdialysis. After 30 minutes of therapy, bleeding was controlled by manual compression and all surviving animals were observed for 1 hour. RESULTS: After hemodynamic decompensation, AVP resulted in a significantly higher increase of CPP (mean +/- SD; 47 +/- 19 versus 28 +/- 9 mm Hg; p < 0.01) and cerebral venous partial pressure of oxygen (66 +/- 8 versus 49 +/- 9 mm Hg; p < 0.05) compared with NE after 10 minutes of therapy. Hemodynamic data and blood gas variables were not different between groups during the remaining study period. Brain metabolism was found comparable in both groups at any time. CONCLUSIONS: AVP was comparable to NE with respect to hemodynamics and blood gases, as well as brain metabolism in surviving animals throughout the study period. Our findings emphasize the importance of early resuscitation, as neuronal cell damage potentially starts immediately after onset of severe hemorrhage. SN - 0022-5282 UR - https://www.unboundmedicine.com/medline/citation/17414341/Small_volume_resuscitation:_a_randomized_controlled_trial_with_either_norepinephrine_or_vasopressin_during_severe_hemorrhage_ L2 - https://doi.org/10.1097/01.ta.0000240962.62319.c8 DB - PRIME DP - Unbound Medicine ER -