SMALL VOLUME RESUSCITATION FROM HEMORRHAGIC SHOCK IN DOGS WITH HYPERTONIC SALINE-HYDROXYETHYL STARCH SOLUTIONS

The influence of small-volume resuscitation (hypertonic saline-10% hydroxyethyl starch, HS/HES) on liver microcirculation (intravital fluorescence microscopy) was studied in a nonheparinized hemorrhagic shock model [mean arterial pressure (MAP) 40 mmHg for 1 h] in rats. Resuscitation was performed with Ringer lactate (RL, 4-fold shed volume/20 min; n = 7), 10% hydroxyethyl starch 200/0.6 (HES, shed volume/5 min; n = 6), or 7.2% NaCl-10% hydroxyethyl starch 200/0.6 (HS/HES, 10% shed volume/2 min; n = 7). One hour after resuscitation, MAP increased in all groups, but it did not return to preshock values (P < 0.05). HES (16 +/- 2% nonperfused sinusoids) and HS/HES (14 +/- 2% nonperfused sinusoids), but not RL (24 +/- 2% nonperfused sinusoids), reduced (P < 0.05) shock-induced sinusoidal perfusion failure (28 +/- 3%) with restoration of leukocyte velocity in sinusoids (S) and postsinusoidal venules (V). Shock-induced stasis/adherence of leukocytes was further increased (P < 0.05) after resuscitation with RL (S, 38 +/- 6%; V, 55 +/- 20%) and HES (S, 31 +/- 8%; V, 23 +/- 14%). In contrast, resuscitation with HS/HES prevented increased leukocyte stasis in sinusoids (-4 +/- 4%) as well as adherence to endothelial lining of postsinusoidal venules (-5 +/- 10%). We conclude that replacement of only 10% of actual blood loss by means of small-volume resuscitation (HS/HES) can restore hepatic microvascular perfusion and prevent reperfusion-induced leukocyte stasis/adherence.

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Hypertonic Saline Dextran Does Not Increase Cardiac Contractile Function During Small Volume Resuscitation from Hemorrhagic Shock in Anesthetized Pigs

Anesthesia & Analgesia ◽

10.1213/00000539-199506000-00006 ◽

1995 ◽

Vol 80 (6) ◽

pp. 1099-1107

Author(s):

M. Welte ◽

T. Goresch ◽

L. Frey ◽

K. Holzer ◽

B. Zwissler ◽

...

Keyword(s):

Hemorrhagic Shock ◽

Hypertonic Saline ◽

Small Volume ◽

Contractile Function ◽

Volume Resuscitation ◽

Cardiac Contractile Function ◽

Cardiac Contractile

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Amiloride combined with small-volume resuscitation with hypertonic saline is superior in ameliorating trauma-hemorrhagic shock-induced lung injury in rats to the administration of either agent alone

Critical Care Medicine ◽

10.1097/01.ccm.0000186770.59312.44 ◽

2005 ◽

Vol 33 (11) ◽

pp. 2592-2598 ◽

Cited By ~ 15

Author(s):

Naohiko Fujiyoshi ◽

Edwin A. Deitch ◽

Eleonora Feketeova ◽

Qi Lu ◽

Tamara L. Berezina ◽

...

Keyword(s):

Lung Injury ◽

Hemorrhagic Shock ◽

Hypertonic Saline ◽

Small Volume ◽

Volume Resuscitation

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Small volume resuscitation with 3% hypertonic saline solution decrease inflammatory response and attenuates end organ damage after controlled hemorrhagic shock

The American Journal of Surgery ◽

10.1016/j.amjsurg.2009.01.017 ◽

2009 ◽

Vol 198 (3) ◽

pp. 407-414 ◽

Cited By ~ 27

Author(s):

Rodrigo Vincenzi ◽

Lourdes A. Cepeda ◽

William M. Pirani ◽

Paulina Sannomyia ◽

Mauricio Rocha-e-Silva ◽

...

Keyword(s):

Inflammatory Response ◽

Hemorrhagic Shock ◽

Hypertonic Saline ◽

Small Volume ◽

Saline Solution ◽

Organ Damage ◽

Volume Resuscitation ◽

Hypertonic Saline Solution ◽

End Organ Damage

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Small Volume Resuscitation With Hypertonic Saline Is More Effective in Ameliorating Trauma-Hemorrhagic Shock-Induced Lung Injury, Neutrophil Activation and Red Blood Cell Dysfunction than Pancreatic Protease Inhibition

Journal of Trauma and Acute Care Surgery ◽

10.1097/01.ta.0000184582.55417.77 ◽

2005 ◽

Vol 59 (2) ◽

pp. 266-272 ◽

Cited By ~ 25

Author(s):

Hiroshi Homma ◽

Edwin A. Deitch ◽

Elenora Feketeova ◽

Qi Lu ◽

Tamara L. Berezina ◽

...

Keyword(s):

Lung Injury ◽

Blood Cell ◽

Hemorrhagic Shock ◽

Hypertonic Saline ◽

Red Blood Cell ◽

Small Volume ◽

Volume Resuscitation ◽

Protease Inhibition ◽

Cell Dysfunction ◽

Pancreatic Protease

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Small-Volume Resuscitation from Hemorrhagic Shock by Hypertonic Saline Dextran – Conceptional Basis and Historical Background

European Surgical Research ◽

10.1159/000048900 ◽

2002 ◽

Vol 34 (1-2) ◽

pp. 138-144 ◽

Cited By ~ 7

Author(s):

Uwe Kreimeier ◽

Stephan Prueckner

Keyword(s):

Hemorrhagic Shock ◽

Hypertonic Saline ◽

Small Volume ◽

Historical Background ◽

Volume Resuscitation

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Less Impairment of Hemostasis and Reduced Blood Loss in Pigs After Resuscitation from Hemorrhagic Shock Using the Small-Volume Concept with Hypertonic Saline/Hydroxyethyl Starch as Compared to Administration of 4% Gelatin or 6% Hydroxyethyl Starch Solution

Anesthesia & Analgesia ◽

10.1213/ane.0b013e318165df18 ◽

2008 ◽

Vol 106 (4) ◽

pp. 1078-1086 ◽

Cited By ~ 32

Author(s):

Thorsten Haas ◽

Dietmar Fries ◽

Carmen Holz ◽

Petra Innerhofer ◽

Werner Streif ◽

...

Keyword(s):

Blood Loss ◽

Hemorrhagic Shock ◽

Hypertonic Saline ◽

Hydroxyethyl Starch ◽

Small Volume ◽

Starch Solution

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In VivoEvaluation of the Ameliorating Effects of Small-Volume Resuscitation with Four Different Fluids on Endotoxemia-Induced Kidney Injury

Mediators of Inflammation ◽

10.1155/2015/726243 ◽

2015 ◽

Vol 2015 ◽

pp. 1-9 ◽

Cited By ~ 1

Author(s):

Yan-ling Wang ◽

Jing-hui Chen ◽

Qiong-fang Zhu ◽

Gao-feng Yu ◽

Chen-fang Luo ◽

...

Keyword(s):

Hypertonic Saline ◽

Hydroxyethyl Starch ◽

Small Volume ◽

Resistance Index ◽

Kidney Injury ◽

Systemic Circulation ◽

Renal Hemodynamics ◽

Volume Resuscitation ◽

Protective Effects ◽

Arterial Blood

Acute kidney injury associated with renal hypoperfusion is a frequent and severe complication during sepsis. Fluid resuscitation is the main therapy. However, heart failure is usually lethal for those patients receiving large volumes of fluids. We compared the effects of small-volume resuscitation using four different treatment regimens, involving saline, hypertonic saline (HTS), hydroxyethyl starch (HES), or hypertonic saline hydroxyethyl starch (HSH), on the kidneys of rats treated with lipopolysaccharide (LPS) to induce endotoxemia. LPS injection caused reduced and progressively deteriorated systemic (arterial blood pressure) and renal hemodynamics (renal blood flow and renal vascular resistance index) over time. This deterioration was accompanied by marked renal functional and pathological injury, as well as an oxidative and inflammatory response, manifesting as increased levels of tumor necrosis factor-α, nitric oxide, and malondialdehyde and decreased activity of superoxide dismutase. Small-volume perfusion with saline failed to improve renal and systemic circulation. However, small-volume perfusion with HES and HSH greatly improved the above parameters, while HTS only transiently improved systemic and renal hemodynamics with obvious renal injury. Therefore, single small-volume resuscitation with HES and HSH could be valid therapeutic approaches to ameliorate kidney injury induced by endotoxemia, while HTS transiently delays injury and saline shows no protective effects.

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