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Short-Term Crystalloid Fluid Resuscitation in Uncontrolled Intra-abdominal Bleeding in Swine

Published online by Cambridge University Press:  28 June 2012

Louis Riddez ,
Hans Hjelmqvist ,
Anders Suneson  and
Robert G. Hahn
Louis Riddez*
Affiliation:
Department of Surgery, Söder Hospital, Stockholm, Sweden
Hans Hjelmqvist
Affiliation:
Department of Anesthesiology, Huddinge University Hospital, Huddinge, Sweden Swedish National Defense Research Establishment, Ursvik, Sweden
Anders Suneson
Affiliation:
Swedish National Defense Research Establishment, Ursvik, Sweden
Robert G. Hahn
Affiliation:
Department of Anesthesiology, Söder Hospital, Stockholm, Sweden
*
Department of Surgery Söder Hospital S-118 83 Stockholm, Sweden Telephone +46 8 616 2328 Telefax +46 8 616 2309 E-mail: [email protected]
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Abstract

Introduction:

Fluid therapy in uncontrolled bleeding is controversial. In a previously used experimental animal model of aortic injury, the outcome often was impaired by re-bleeding that began at least 20 minutes after crystalloid fluid resuscitation was initiated. Therefore, it was hypothesized that re-bleeding might be avoided if volume loading is carried out for 20 minutes and then disconstinued.

Methods:

Ten minutes after a 5 mm laceration was produced in the infra-renal aorta on eight anesthetized pigs, they received a 20-minute intravenous infusion of Ringer's solution in the ratio of 1:1 to the expected blood loss. Hemodynamics were studied for 120 minutes using arterial and pulmonary artery catheters and blood flow probes placed proximal and distal to the aortic lesion and around the left renal artery and portal vein.

Results:

The bleeding stopped between three and four minutes after the onset of bleeding. The blood flow rate dropped to 38% (mean) of baseline in the splanchnic region, to 31% in the upper aorta, and to 13% in the kidney. The flow rates and the oxygen consumption increased transiently during fluid resuscitation, but never reached baseline levels. Re-bleeding amounted to about 15% of the initial bleeding and occurred in only three of the animals. Four of the pigs died of shock within 90 minutes (range 47–85 minutes) after the aortic injury.

Conclusion:

Short-term crystalloid fluid therapy in uncontrolled aortic hemorrhage transiently improved the hemodynamic status and the oxygen consumption following the initial bleeding. Furthermore, the infusion did not cause re-bleeding of more than 100 ml, which occurred in previously conducted experiments when the infusion was continued for more than 20 minutes.

Keywords

acidosiscrystalloid solutionshemorrhagehemorrhagic shockhypovolemiaintravenous fluidsmetabolic acidosisoutcomeoxygen debtresuscitationRinger's solutionshock
Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 14 , Issue 2 , June 1999 , pp. 55 - 60
Copyright
Copyright © World Association for Disaster and Emergency Medicine 1999

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References

1. Smith, JP, Bodai, BI, Hill, AS, Frey, CF: Prehospital stabilization of critically injured patients: a failed concept. J Trauma 1985;25:65–70.CrossRefGoogle ScholarPubMed
2. Lewìs, FR: Prehospital intravenous fluid therapy: Physiologic computer modeling. J Trauma 1986;26:804–811.CrossRefGoogle Scholar
3. Riddez, L, Johnsson, L, Hahn, RG: Central and regional hemodynamics during fluid therapy after uncontrolled intra-abdominal bleeding. J Trauma, in press.Google Scholar
4. Bickell, WH, Bruttig, SP, Millnamow, GA, O'Benar, J, Wade, CE: The detrimental effects of intravenous crystalloid after aortotomy in swine. Surgery 1991;110:529–536.Google ScholarPubMed
5. Kowalenko, T, Stern, S, Dronen, S, Wang, X: Improved outcome with hypotensive resuscitation of uncontrolled hemorrhagic shock in a swine model. J Trauma 1992;33:349–353.CrossRefGoogle Scholar
6. Stern, SA, Dronen, SC, Birrer, P, Wang, X: Effect of blood pressure on hemorrhage volume and survival in a near-fatal hemorrhage model incorporating a vascular injury. Ann Emerg Med 1993;22:155–163.CrossRefGoogle Scholar
7. Capone, AC, Safar, P, Stezoski, W, Tisherman, S, Peitzman, AB: Improved outcome with fluid resuscitation in treatment of uncontrolled hemorrhagic shock. J Am Coll Surg 1995;180:269–276.Google ScholarPubMed
8. Krausz, MM, Kablan, M, Rabinovici, R, Klin, B, Sherman, Y, Gross, D: Effect of injured vessel size on bleeding following hypertonic saline infusion in “uncontrolled” hemorrhagic shock in anesthetized rats. Circulatory Shock 1991;35:9–13.Google ScholarPubMed
9. Tokics, L, Brismar, B, Hedenstierna, G, Lundh, R: Oxygen uptake and central circulation during ketamine anaesthesia. Acta Anaesthesiologica Scandinavica 1983;27:318–322.CrossRefGoogle ScholarPubMed
10. Kveim, M, Nesbakken, R: Utilization of exogenous acetate during canine hemorrhagic shock. Scandinavian Journal of Clinical & Laboratory Investigation 1979;39:653–658.CrossRefGoogle Scholar
11. Riddez, L, Hahn, R, Brismar, B, Strandberg, Å, Svensén, C, Hedenstierna, G: Central and regional hemodynamics during acute hypovolemia and volume substitution in volunteers. Crit Care Med 1997;25:635–640.Google Scholar
12. Siegel, JH, Fabian, M, Smith, JA, Constantino, D: Use of recombinant hemoglobin solution in reversing lethal hemorrhagic hypovolemic oxygen debt shock. J Trauma 1997;42:199–212.CrossRefGoogle ScholarPubMed
13. Bickell, WH, Bruttig, SP, Wade, CE: Hemodynamic response to abdominal aortotomy in the anesthetized swine. Circulatory Shock 1989;28:321–332.Google ScholarPubMed
14. Shaftan, GW, Chiu, C-J, Dennis, C, Harris, B: Fundamentals of physiologic control of arterial hemorrhage. Surgery 1965;58:851–856.Google ScholarPubMed
15. Bickell, WH, Wall, MJ, Pepe, PE, Martin, RR, Ginger, VF, Allen, MK, Mattox, KL: Immediate versus delayed fluid resuscitation for hypotensive patients with penetrating torso injuries. N Engl J Med 1994;331: 1105–1109.CrossRefGoogle ScholarPubMed
16. Secher, NH, Bie, P: Bradycardia during reversible haemorrhagic shock — A forgotten observation? Clinical Physiology 1985;5:315–323.CrossRefGoogle ScholarPubMed