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Resuscitation of haemorrhagic shock with normal saline vs. lactated Ringer's: effects on oxygenation, extravascular lung water and haemodynamics.
Crit Care. 2009; 13(2):R30.CC

Abstract

INTRODUCTION

Pulmonary oedema and impairment of oxygenation are reported as common consequences of haemorrhagic shock and resuscitation (HSR). Surprisingly, there is little information in the literature examining differences in crystalloid type during the early phase of HSR regarding the development of pulmonary oedema, the impact on oxygenation and the haemodynamic response. These experiments were designed to determine if differences exist because of crystalloid fluid type in the development of oedema, the impact on oxygenation and the haemodynamic response to fluid administration in early HSR.

METHODS

Twenty anaesthetised swine underwent a grade V liver injury and bled without resuscitation for 30 minutes. The animals were randomised to receive, in a blinded fashion, either normal saline (NS; n = 10) or lactated Ringer's solution (LR; n = 10). They were then resuscitated with study fluid to, and maintained at, the preinjury mean arterial pressure (MAP) for 90 minutes.

RESULTS

Extravascular lung water index (EVLWI) began to increase immediately with resuscitation with both fluid types, increasing earlier and to a greater degree with NS. A 1 ml/kg increase in EVLWI from baseline occurred after administartion of (mean +/- standard error of the mean) 68.6 +/- 5.2 ml/kg of normal saline and 81.3 +/- 8.7 ml/kg of LR (P = 0.027). After 150 ml/kg of fluid, EVLWI increased from 9.5 +/- 0.3 ml/kg to 11.4 +/- 0.3 ml/kg NS and from 9.3 +/- 0.2 ml/kg to 10.8 +/- 0.3 ml/kg LR (P = 0.035). Despite this, oxygenation was not significantly impacted (Delta partial pressure of arterial oxygen (PaO2)/fraction of inspired oxygen (FiO2) <or= 100) until approximately 250 ml/kg of either fluid had been administered. Animals resuscitated with NS were more acidaemic (with lower lactates), pH 7.17 +/- 0.03 NS vs. 7.41 +/- 0.02 LR (P < 0.001).

CONCLUSIONS

This study suggests that early resuscitation of haemorrhagic shock with NS or LR has little impact on oxygenation when resuscitation volume is less than 250 ml/kg. LR has more favourable effects than NS on EVLWI, pH and blood pressure but not on oxygenation.

Authors+Show Affiliations

Department of Medicine, Division of Pulmonary and Critical Care Medicine, Oregon Health and Science University, Physicians Pavilion, Suite 340, 3181 SW Sam Jackson Park Road, Portland, OR 97239, USA. phillipc@ohsu.eduNo 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
Research Support, U.S. Gov't, Non-P.H.S.

Language

eng

PubMed ID

19257901

Citation

Phillips, Charles R., et al. "Resuscitation of Haemorrhagic Shock With Normal Saline Vs. Lactated Ringer's: Effects On Oxygenation, Extravascular Lung Water and Haemodynamics." Critical Care (London, England), vol. 13, no. 2, 2009, pp. R30.
Phillips CR, Vinecore K, Hagg DS, et al. Resuscitation of haemorrhagic shock with normal saline vs. lactated Ringer's: effects on oxygenation, extravascular lung water and haemodynamics. Crit Care. 2009;13(2):R30.
Phillips, C. R., Vinecore, K., Hagg, D. S., Sawai, R. S., Differding, J. A., Watters, J. M., & Schreiber, M. A. (2009). Resuscitation of haemorrhagic shock with normal saline vs. lactated Ringer's: effects on oxygenation, extravascular lung water and haemodynamics. Critical Care (London, England), 13(2), R30. https://doi.org/10.1186/cc7736
Phillips CR, et al. Resuscitation of Haemorrhagic Shock With Normal Saline Vs. Lactated Ringer's: Effects On Oxygenation, Extravascular Lung Water and Haemodynamics. Crit Care. 2009;13(2):R30. PubMed PMID: 19257901.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Resuscitation of haemorrhagic shock with normal saline vs. lactated Ringer's: effects on oxygenation, extravascular lung water and haemodynamics. AU - Phillips,Charles R, AU - Vinecore,Kevin, AU - Hagg,Daniel S, AU - Sawai,Rebecca S, AU - Differding,Jerome A, AU - Watters,Jennifer M, AU - Schreiber,Martin A, Y1 - 2009/03/04/ PY - 2008/10/30/received PY - 2008/12/29/revised PY - 2009/03/04/accepted PY - 2009/3/5/entrez PY - 2009/3/5/pubmed PY - 2009/9/9/medline SP - R30 EP - R30 JF - Critical care (London, England) JO - Crit Care VL - 13 IS - 2 N2 - INTRODUCTION: Pulmonary oedema and impairment of oxygenation are reported as common consequences of haemorrhagic shock and resuscitation (HSR). Surprisingly, there is little information in the literature examining differences in crystalloid type during the early phase of HSR regarding the development of pulmonary oedema, the impact on oxygenation and the haemodynamic response. These experiments were designed to determine if differences exist because of crystalloid fluid type in the development of oedema, the impact on oxygenation and the haemodynamic response to fluid administration in early HSR. METHODS: Twenty anaesthetised swine underwent a grade V liver injury and bled without resuscitation for 30 minutes. The animals were randomised to receive, in a blinded fashion, either normal saline (NS; n = 10) or lactated Ringer's solution (LR; n = 10). They were then resuscitated with study fluid to, and maintained at, the preinjury mean arterial pressure (MAP) for 90 minutes. RESULTS: Extravascular lung water index (EVLWI) began to increase immediately with resuscitation with both fluid types, increasing earlier and to a greater degree with NS. A 1 ml/kg increase in EVLWI from baseline occurred after administartion of (mean +/- standard error of the mean) 68.6 +/- 5.2 ml/kg of normal saline and 81.3 +/- 8.7 ml/kg of LR (P = 0.027). After 150 ml/kg of fluid, EVLWI increased from 9.5 +/- 0.3 ml/kg to 11.4 +/- 0.3 ml/kg NS and from 9.3 +/- 0.2 ml/kg to 10.8 +/- 0.3 ml/kg LR (P = 0.035). Despite this, oxygenation was not significantly impacted (Delta partial pressure of arterial oxygen (PaO2)/fraction of inspired oxygen (FiO2) <or= 100) until approximately 250 ml/kg of either fluid had been administered. Animals resuscitated with NS were more acidaemic (with lower lactates), pH 7.17 +/- 0.03 NS vs. 7.41 +/- 0.02 LR (P < 0.001). CONCLUSIONS: This study suggests that early resuscitation of haemorrhagic shock with NS or LR has little impact on oxygenation when resuscitation volume is less than 250 ml/kg. LR has more favourable effects than NS on EVLWI, pH and blood pressure but not on oxygenation. SN - 1466-609X UR - https://www.unboundmedicine.com/medline/citation/19257901/Resuscitation_of_haemorrhagic_shock_with_normal_saline_vs__lactated_Ringer's:_effects_on_oxygenation_extravascular_lung_water_and_haemodynamics_ L2 - https://ccforum.biomedcentral.com/articles/10.1186/cc7736 DB - PRIME DP - Unbound Medicine ER -