Abstract 1807: Low-volume Resuscitation From Traumatic Hemorrhagic Shock With Na+/H+ Exchanger Inhibitor

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Dongmei Wu ◽  
Hui Dai ◽  
Jaqueline Arias ◽  
Loren Latta
Keyword(s):  
Hemorrhagic Shock ◽  
Fluid Resuscitation ◽  
Soft Tissue Injury ◽  
Hemodynamic Response ◽  
Fluid Replacement ◽  
Male Rats ◽  
List Type ◽  
Volume Resuscitation ◽  
Low Volume ◽  
Traumatic Hemorrhagic Shock

Background: Severe hemorrhage from traumatic injury is a major causative factor in almost half of these deaths on the battlefield, especially during the early period (<2h) after injury. Intervention with low-volume fluid resuscitation is increasingly preferred than more aggressive fluid replacement. We evaluated the use of a Na+/H+ exchanger (NHE) inhibitor, as a cardioprotective adjunct therapy to low-volume resuscitation in a rat model of traumatic hemorrhagic shock. Methods: Femur fracture with soft tissue injury was induced in 28 anesthetized male rats. The animals were then bled via the carotid artery to maintain a mean arterial pressure of 40 mmHg for 20 minutes. Groups: no therapy; 15 ml/kg Hextend infusion over 40 minutes; 3 mg/kg BIIB513 (NHE-1 inhibitor) + 15 ml/kg Hextend infusion over 40 minutes. After 4 hours, the animals who survived received a second infusion of Hextend. The experiment was terminated at 6 hours after initial resuscitation. Data are reported as mean ± SD. Results: All animals in the no therapy group died within 2 hours. Compared to Hextend infusion alone, the addition of NHE-1 inhibition with BIIB513, improved the hemodynamic response to fluid resuscitation (Fig 1 ), increased blood oxygen content, prevented metabolic acidosis, and improved 6 hour survival (42% in Hextend group vs 80% in BIIB513 + Hextend group). NHE-1 inhibition also resulted in reduced plasma levels of TNF-α, ICAM-1 and C-reactive protein, and attenuated neutrophil infiltration in the liver. Conclusion : NHE-1 inhibition with BIIB513 improved the hemodynamic response to fluid resuscitation, attenuated tissue inflammatory mediators, and most importantly improved survival.

Low-volume resuscitation from traumatic hemorrhagic shock with Na+/H+ exchanger inhibitor*

2009 ◽  
Vol 37 (6) ◽  
pp. 1994-1999 ◽  
Author(s):  
Dongmei Wu ◽  
Hui Dai ◽  
Jaqueline Arias ◽  
Loren Latta ◽  
William M. Abraham
Keyword(s):  
Hemorrhagic Shock ◽  
Volume Resuscitation ◽  
Low Volume ◽  
Traumatic Hemorrhagic Shock

A Comparison of the Hemoglobin-Based Oxygen Carrier HBOC-201 to Other Low-Volume Resuscitation Fluids in a Model of Controlled Hemorrhagic Shock

2003 ◽  
Vol 55 (4) ◽  
pp. 747-754 ◽  
Author(s):  
CPT James B. Sampson ◽  
CPT Michael R. Davis ◽  
MAJ Deborah L. Mueller ◽  
LT Vikram S. Kashyap ◽  
LT Donald H. Jenkins ◽  
...  
Keyword(s):  
Hemorrhagic Shock ◽  
Oxygen Carrier ◽  
Volume Resuscitation ◽  
Low Volume

Abstract 16745: It Would be Possible to Rescue Traumatic Hemorrhagic Shock Patients Who Failed to Fluid Resuscitation (Fluid Non-responder) but Succeed in REBOA Resuscitation (REBOA/IABO Responder)

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Tomohiko Orita ◽  
Tomohiro Funabiki ◽  
Motoyasu Yamazaki ◽  
Masayuki Shimizu ◽  
Tomohiro Sato ◽  
...  
Keyword(s):  
Survival Rate ◽  
Hemorrhagic Shock ◽  
Fluid Resuscitation ◽  
Recovery Rate ◽  
Balloon Occlusion ◽  
Shock State ◽  
Occlusion Time ◽  
Aortic Balloon Occlusion ◽  
Significant Difference ◽  
Traumatic Hemorrhagic Shock

Introduction: Fluid resuscitation (FR) and massive transfusion protocol (MTP) are important initial strategies for traumatic hemorrhagic shock cases. But poor responded patients to them are difficult to rescue. In such cases, open aortic cross clamping or intra-aortic balloon occlusion (IABO) would be performed as a temporary hemostasis treatment. Recently, IABO for severe trauma has been named resuscitative endovascular balloon occlusion of the aorta (REBOA). But it is still unclear which case can be rescued with REBOA. So we studied the relationship between the responsiveness to FR and REBOA. Methods: Consecutive 46 traumatic hemorrhagic shock patients underwent REBOA at our ER for last 86 months were included. All of their FAST were positive and done FR and MTP as a first-line resuscitation. 10Fr or 7Fr IABO devices were inserted at supraphrenic level (zone I) and underwent fundamental hemostasis by operative management (OM) and/or transcatheter arterial embolization (TAE). They were sorted into responded group or non-responded group for REBOA. The primary end point was a recovery rate from the shock state within 48 hours. Secondary end points were a survival rate in 30th days and a rate of complications. Results: 26 transient or non-responded patients (Fluid Non-responder) responded for REBOA (REBOA Responder group). 20 Fluid Non-responders did not respond for REBOA (REBOA Non-responder group). There were no significant differences in ISS (REBOA Responder vs. Non-responder: 45.8+/-15.2 vs. 54.8+/-22.3), amount of total fluid (7187+/-5782ml vs. 6772+/-4851) and total blood transfusion (4816+/-3006ml vs. 5080+/-3330), required time to occlude after arriving ER (25.3+/-12.6min vs. 19.4+/-9.8) and total occlusion time (76.4+/-66.5min vs. 92.7+/-34.4). There was significant difference in the changes of systolic blood pressure before and after of REBOA (59.3+/-25.7mmHg vs. 38.3+/-39.4, p=0.04). A recovery rate from shock state was 65%(12/26) vs. 0%(0/20) (p<0.01) and a survival rate was 14/26(54%) vs. 0/20(0%) (p<0.01). One complication occurred in REBOA Responder group but was not lethal. Conclusions: It would be necessary to recognize that Fluid Non-responder but REBOA Responder with traumatic hemorrhagic shock could be possible to rescue.

scholarly journals Low-volume resuscitation using polyethylene glycol-20k in a preclinical porcine model of hemorrhagic shock

2016 ◽  
Vol 81 (6) ◽  
pp. 1056-1062 ◽  
Author(s):  
Valerie Plant ◽  
Ashley Limkemann ◽  
Loren Liebrecht ◽  
Charles Blocher ◽  
Paula Ferrada ◽  
...  
Keyword(s):  
Polyethylene Glycol ◽  
Hemorrhagic Shock ◽  
Porcine Model ◽  
Volume Resuscitation ◽  
Low Volume ◽  
Preclinical Porcine Model

Abstract 2049: Fluid Resuscitation with Na+/h+ Exchanger Inhibitor Improves Cardiovascular and Metabolic Function in a Pig Model of Uncontrolled Hemorrhagic Shock

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Dongmei Wu ◽  
Hui Dai ◽  
Jiansong Qi ◽  
William Abraham
Keyword(s):  
Hemorrhagic Shock ◽  
Fluid Resuscitation ◽  
Troponin I ◽  
Nuclear Translocation ◽  
Tissue Injury ◽  
Soft Tissue Injury ◽  
Heart Association ◽  
Neutrophil Infiltration ◽  
Myeloperoxidase Activity ◽  
Stroke Index

Uncontrolled hemorrhage remains a leading cause of traumatic death. The aim of this study was to evaluate the effects of Na+/H+ exchanger (NHE) inhibition on enhancing fluid resuscitation outcomes in traumatic hemorrhagic shock, and to investigate the mechanisms related to NHE inhibitor -induced protection and recovery from hemorrhagic shock. Tibia fractures with soft tissue injury were induced in 12 anesthetized instrumented male pigs. The animals underwent hemorrhage of 25ml/kg for 20min, followed by a 4mm abdominal aortic tear with surgical repair after 30minutes. Animals then underwent initial fluid resuscitation with either 15ml/kg Hextend (n=6) or 3mg/kg BIIB513 +15ml/kg Hextend (n=6). Resuscitation occurred over 40 minutes. A second resuscitation was given 4 hours later. Studies were terminated at 6 hours. All animals survived the entire experiment. In both groups , hemorrhage resulted in similar impaired myocardial performance, and severe hemodynamic and metabolic alterations. Compared to resuscitation with Hextend alone, the addition of BIIB513, improved the hemodynamic response to fluid resuscitation showing a 23% increase in mean blood pressure and a 31% increase in blood oxygen content, as well as preventing metabolic acidosis during early resuscitation. Echocardiography analysis showed that NHE-1 inhibition with BIIB513 attenuated the hemorrhage induced myocardial hypercontracture and resulted in a significant 77% increase in stroke index. NHE-1 inhibition also reduced plasma levels of myocardial troponin-I by 88%, attenuated myeloperoxidase activity in the liver by 46%, and improved organ function. Consistent with this was the finding that nuclear factor (NF)-κB phosphorylation, nuclear translocation, and NF-κB DNA binding activity in the liver was attenuated in Hextend + BIIB513 treated animals, compared to Hextend only treated animals. The present study shows that the response to fluid resuscitation after traumatic hemorrhage is improved by the addition of the NHE-1 inhibitor BIIB513. That BIIB513 treatment attenuates NF-κB activation and neutrophil infiltration suggests that this improvement may be related to the reduction in tissue inflammatory injury. This research has received full or partial funding support from the American Heart Association, AHA National Center.

scholarly journals Fluid Resuscitation and Massive Transfusion Protocol in Pediatric Trauma

2016 ◽  
Vol 33 (2) ◽  
pp. 91-99
Author(s):  
Vesna Marjanović ◽  
Ivana Budić
Keyword(s):  
Hemorrhagic Shock ◽  
Fluid Resuscitation ◽  
Early Identification ◽  
Massive Transfusion ◽  
Pediatric Trauma ◽  
Current Data ◽  
Trauma Patients ◽  
Volume Resuscitation ◽  
Massive Transfusion Protocol ◽  
Transfusion Protocol

Summary Trauma is the leading cause of morbidity and mortality in children due to the occurrence of hemorrhagic shock. Hemorrhagic shock and its consequences, anemia and hypovolemia, decrease oxygen delivery, due to which appropriate transfusion and volume resuscitation are critical. Guidelines for massive transfusion, in the pediatric trauma, have not been defined yet. Current data indicate that early identification of coagulopathy and its treatment with RBSs, plasma and platelets in a 1:1:1 unit ratio, and limited use of crystalloids may improve survival in pediatric trauma patients.

scholarly journals Microvascular gut oxygenation measured by Pd-porphyrin phosphorescence during severe hemorrhagic shock and low volume resuscitation with DCLHb™ in pigs

Critical Care ◽  
10.1186/cc79 ◽  
1997 ◽  
Vol 1 (Suppl 1) ◽  
pp. P093
Author(s):  
M van Iterson ◽  
M Sinaasappel ◽  
HR Hansen ◽  
CW Verlaan ◽  
K Burhop ◽  
...  
Keyword(s):  
Hemorrhagic Shock ◽  
Volume Resuscitation ◽  
Low Volume
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