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Cerebral effects of three resuscitation protocols in uncontrolled haemorrhagic shock: a randomised controlled experimental study.
Resuscitation. 2009 May; 80(5):567-72.R

Abstract

BACKGROUND

To compare haemodynamic and cerebral variables during aggressive fluid resuscitation vs. administration of a hypertonic starch solution (HS) combined with either noradrenaline [norepinephrine] or arginine vasopressin in an animal model of uncontrolled haemorrhagic shock.

METHODS

After Animal Investigational Committee approval, 24 anaesthetised pigs underwent a liver trauma. At haemodynamic decompensation, animals were randomly assigned to receive fluid resuscitation (6% HES 130/0.4, 20 mL/kg, and Ringer, 40 mL/kg; FR group, n=8), or noradrenaline (bolus 20 microg/kg, continuously 1 microg/kg/min) combined with HS (7.2% NaCl/6% HES 200/0.5; 4 mL/kg) (n=8; NA/HS group), or vasopressin (bolus 0.2U/kg, continuously 0.04 U/kg/min) combined with HS (4 mL/kg) (n=8; AVP/HS group), respectively. Thirty minutes after drug administration, bleeding was controlled manually.

RESULTS

Mean arterial blood pressure (MAP), cerebral perfusion pressure (CPP), and brain tissue oxygen pressure (P(bt)O(2)) decreased significantly with haemorrhage in all groups (p<0.05). AVP/HS resulted in a faster and higher increase of MAP and CPP compared to both NA/HS and FR (p<0.001 vs. FR; p<0.01 vs. NA/HS). Compared to FR, P(bt)O(2) increased faster with AVP/HS and NA/HS (p<0.05) after therapy, and ICP was lower at the end of the study period (p<0.05). All animals (8/8) of the AVP/HS group survived, compared to 4/8 and 4/8 in the NA/HS and FR group, respectively (p=0.07).

CONCLUSIONS

Following uncontrolled haemorrhagic shock in this animal model, combination of HS with arginine vasopressin increased CPP and cerebral oxygenation faster than aggressive fluid resuscitation, without re-increasing ICP.

Authors+Show Affiliations

Department of Anaesthesiology and Intensive Care Medicine, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany. e.cavus@t-online.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
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

19217706

Citation

Cavus, Erol, et al. "Cerebral Effects of Three Resuscitation Protocols in Uncontrolled Haemorrhagic Shock: a Randomised Controlled Experimental Study." Resuscitation, vol. 80, no. 5, 2009, pp. 567-72.
Cavus E, Meybohm P, Doerges V, et al. Cerebral effects of three resuscitation protocols in uncontrolled haemorrhagic shock: a randomised controlled experimental study. Resuscitation. 2009;80(5):567-72.
Cavus, E., Meybohm, P., Doerges, V., Hugo, H. H., Steinfath, M., Nordstroem, J., Scholz, J., & Bein, B. (2009). Cerebral effects of three resuscitation protocols in uncontrolled haemorrhagic shock: a randomised controlled experimental study. Resuscitation, 80(5), 567-72. https://doi.org/10.1016/j.resuscitation.2009.01.013
Cavus E, et al. Cerebral Effects of Three Resuscitation Protocols in Uncontrolled Haemorrhagic Shock: a Randomised Controlled Experimental Study. Resuscitation. 2009;80(5):567-72. PubMed PMID: 19217706.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Cerebral effects of three resuscitation protocols in uncontrolled haemorrhagic shock: a randomised controlled experimental study. AU - Cavus,Erol, AU - Meybohm,Patrick, AU - Doerges,Volker, AU - Hugo,Hans-Hermann, AU - Steinfath,Markus, AU - Nordstroem,Johann, AU - Scholz,Jens, AU - Bein,Berthold, Y1 - 2009/02/14/ PY - 2008/11/13/received PY - 2009/01/15/revised PY - 2009/01/19/accepted PY - 2009/2/17/entrez PY - 2009/2/17/pubmed PY - 2009/6/26/medline SP - 567 EP - 72 JF - Resuscitation JO - Resuscitation VL - 80 IS - 5 N2 - BACKGROUND: To compare haemodynamic and cerebral variables during aggressive fluid resuscitation vs. administration of a hypertonic starch solution (HS) combined with either noradrenaline [norepinephrine] or arginine vasopressin in an animal model of uncontrolled haemorrhagic shock. METHODS: After Animal Investigational Committee approval, 24 anaesthetised pigs underwent a liver trauma. At haemodynamic decompensation, animals were randomly assigned to receive fluid resuscitation (6% HES 130/0.4, 20 mL/kg, and Ringer, 40 mL/kg; FR group, n=8), or noradrenaline (bolus 20 microg/kg, continuously 1 microg/kg/min) combined with HS (7.2% NaCl/6% HES 200/0.5; 4 mL/kg) (n=8; NA/HS group), or vasopressin (bolus 0.2U/kg, continuously 0.04 U/kg/min) combined with HS (4 mL/kg) (n=8; AVP/HS group), respectively. Thirty minutes after drug administration, bleeding was controlled manually. RESULTS: Mean arterial blood pressure (MAP), cerebral perfusion pressure (CPP), and brain tissue oxygen pressure (P(bt)O(2)) decreased significantly with haemorrhage in all groups (p<0.05). AVP/HS resulted in a faster and higher increase of MAP and CPP compared to both NA/HS and FR (p<0.001 vs. FR; p<0.01 vs. NA/HS). Compared to FR, P(bt)O(2) increased faster with AVP/HS and NA/HS (p<0.05) after therapy, and ICP was lower at the end of the study period (p<0.05). All animals (8/8) of the AVP/HS group survived, compared to 4/8 and 4/8 in the NA/HS and FR group, respectively (p=0.07). CONCLUSIONS: Following uncontrolled haemorrhagic shock in this animal model, combination of HS with arginine vasopressin increased CPP and cerebral oxygenation faster than aggressive fluid resuscitation, without re-increasing ICP. SN - 0300-9572 UR - https://www.unboundmedicine.com/medline/citation/19217706/Cerebral_effects_of_three_resuscitation_protocols_in_uncontrolled_haemorrhagic_shock:_a_randomised_controlled_experimental_study_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0300-9572(09)00053-7 DB - PRIME DP - Unbound Medicine ER -