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Hextend and 7.5% hypertonic saline with Dextran are equivalent to Lactated Ringer's in a swine model of initial resuscitation of uncontrolled hemorrhagic shock.
J Trauma. 2011 Dec; 71(6):1755-60.JT

Abstract

BACKGROUND

The optimal fluid strategy for the early treatment of trauma patients remains highly debated. Our objective was to determine the efficacy of an initial bolus of resuscitative fluids used in military and civilian settings on the physiologic response to uncontrolled hemorrhagic shock in a prospective, randomized, blinded animal study.

METHODS

Fifty anesthetized swine underwent central venous and arterial catheterization followed by celiotomy. Grade V liver injury was performed, followed by 30 minutes of uncontrolled hemorrhage. Then, liver packing was completed, and fluid resuscitation was initiated over 12 minutes with 2 L normal saline (NS), 2 L Lactated Ringer's (LR), 250 mL 7.5% hypertonic saline with 3% Dextran (HTS), 500 mL Hextend (HEX), or no fluid (NF). Animals were monitored for 2 hours postinjury. Blood loss after initial hemorrhage, mean arterial pressure (MAP), tissue oxygen saturation (StO2), hematocrit, pH, base excess, and lactate were measured at baseline, 1 hour, and 2 hours.

RESULTS

NF group had less post-treatment blood loss compared with other groups. MAP and StO2 for HEX, HTS, and LR at 1 hour and 2 hours were similar and higher than NF. MAP and StO2 did not differ between NS and NF, but NS resulted in decreased pH and base excess.

CONCLUSIONS

Withholding resuscitative fluid results in the least amount of posttreatment blood loss. In clinically used volumes, HEX and HTS are equivalent to LR with regard to physiologic outcomes and superior to NF. NS did not provide a measurable improvement in outcome compared with NF and resulted in increased acidosis.

Authors+Show Affiliations

Division of Trauma, Critical Care, and Acute Care Surgery, Department of Surgery, Oregon Health & Science University, Portland, Oregon 97239, USA.No 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, U.S. Gov't, Non-P.H.S.

Language

eng

PubMed ID

22182885

Citation

Riha, Gordon M., et al. "Hextend and 7.5% Hypertonic Saline With Dextran Are Equivalent to Lactated Ringer's in a Swine Model of Initial Resuscitation of Uncontrolled Hemorrhagic Shock." The Journal of Trauma, vol. 71, no. 6, 2011, pp. 1755-60.
Riha GM, Kunio NR, Van PY, et al. Hextend and 7.5% hypertonic saline with Dextran are equivalent to Lactated Ringer's in a swine model of initial resuscitation of uncontrolled hemorrhagic shock. J Trauma. 2011;71(6):1755-60.
Riha, G. M., Kunio, N. R., Van, P. Y., Hamilton, G. J., Anderson, R., Differding, J. A., & Schreiber, M. A. (2011). Hextend and 7.5% hypertonic saline with Dextran are equivalent to Lactated Ringer's in a swine model of initial resuscitation of uncontrolled hemorrhagic shock. The Journal of Trauma, 71(6), 1755-60. https://doi.org/10.1097/TA.0b013e3182367b1c
Riha GM, et al. Hextend and 7.5% Hypertonic Saline With Dextran Are Equivalent to Lactated Ringer's in a Swine Model of Initial Resuscitation of Uncontrolled Hemorrhagic Shock. J Trauma. 2011;71(6):1755-60. PubMed PMID: 22182885.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Hextend and 7.5% hypertonic saline with Dextran are equivalent to Lactated Ringer's in a swine model of initial resuscitation of uncontrolled hemorrhagic shock. AU - Riha,Gordon M, AU - Kunio,Nicholas R, AU - Van,Philbert Y, AU - Hamilton,Gregory J, AU - Anderson,Ross, AU - Differding,Jerome A, AU - Schreiber,Martin A, PY - 2011/12/21/entrez PY - 2011/12/21/pubmed PY - 2012/2/15/medline SP - 1755 EP - 60 JF - The Journal of trauma JO - J Trauma VL - 71 IS - 6 N2 - BACKGROUND: The optimal fluid strategy for the early treatment of trauma patients remains highly debated. Our objective was to determine the efficacy of an initial bolus of resuscitative fluids used in military and civilian settings on the physiologic response to uncontrolled hemorrhagic shock in a prospective, randomized, blinded animal study. METHODS: Fifty anesthetized swine underwent central venous and arterial catheterization followed by celiotomy. Grade V liver injury was performed, followed by 30 minutes of uncontrolled hemorrhage. Then, liver packing was completed, and fluid resuscitation was initiated over 12 minutes with 2 L normal saline (NS), 2 L Lactated Ringer's (LR), 250 mL 7.5% hypertonic saline with 3% Dextran (HTS), 500 mL Hextend (HEX), or no fluid (NF). Animals were monitored for 2 hours postinjury. Blood loss after initial hemorrhage, mean arterial pressure (MAP), tissue oxygen saturation (StO2), hematocrit, pH, base excess, and lactate were measured at baseline, 1 hour, and 2 hours. RESULTS: NF group had less post-treatment blood loss compared with other groups. MAP and StO2 for HEX, HTS, and LR at 1 hour and 2 hours were similar and higher than NF. MAP and StO2 did not differ between NS and NF, but NS resulted in decreased pH and base excess. CONCLUSIONS: Withholding resuscitative fluid results in the least amount of posttreatment blood loss. In clinically used volumes, HEX and HTS are equivalent to LR with regard to physiologic outcomes and superior to NF. NS did not provide a measurable improvement in outcome compared with NF and resulted in increased acidosis. SN - 1529-8809 UR - https://www.unboundmedicine.com/medline/citation/22182885/Hextend_and_7_5_hypertonic_saline_with_Dextran_are_equivalent_to_Lactated_Ringer's_in_a_swine_model_of_initial_resuscitation_of_uncontrolled_hemorrhagic_shock_ L2 - https://doi.org/10.1097/TA.0b013e3182367b1c DB - PRIME DP - Unbound Medicine ER -