Fluid resuscitation using the intraosseous route

Infusion with lactated Ringer's and hetastarch

LT Jeffrey M Carness, Jennifer L. Russell, Rodrigo M. E Lima, Lais H C Navarro, George Kramer

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

Objective: The effectiveness of the intraosseous (IO) route for fluid resuscitation remains uncertain. This study compares IO infusion rates and estimated volume expansion using clinically relevant infusion pressures with lac-tated Ringer's (LR) and hetastarch (HES). Methods: IO needles were placed in the sternum or tibia for infusion of HES and LR in 8 Yorkshire pigs. Pressures were recorded at variable flow rates and linear regression used to identify flow rates at 100 and 400 mm Hg. Volume expansion was calculated for a 10-minute infusion. Results: Mean LR flow rates (mL-min -) were 24/111 (tibia-100/400 mm Hg) and 8/34 (sternum-100/400 mm Hg). The HES flow rates (mL-min -) of 10/44 (tibia-100/400 mm Hg) and 6/26 (sternum-100/400 mm Hg) were significantly lower or ~40% (p < 0.01) of the LR flow rates into the tibia and ~70% (p < 0.05) into the sternum. Mean volume expansion (mL) for a 10-min infusion of LR was estimated to be 80/369 (tibia-100/400 mm Hg) and 27/112 (sternum-100/400 mm Hg). In comparison, HES volume expansion was ~20% higher for the tibia (p > 0.05) and 110% to 120% higher for the sternum (p < 0.05). Conclusion: HES flow rates are lower than LR flow rates in the sternum and tibia of swine. Sternal infusion of HES is likely to provide greater estimated intravascular volume expansion than LR despite the lower infusion rates.

Original languageEnglish (US)
Pages (from-to)222-228
Number of pages7
JournalMilitary Medicine
Volume177
Issue number2
StatePublished - Feb 2012

Fingerprint

Intraosseous Infusions
Hydroxyethyl Starch Derivatives
Sternum
Resuscitation
Tibia
Swine
Pressure
Needles
Linear Models
Ringer's lactate

ASJC Scopus subject areas

  • Medicine(all)
  • Public Health, Environmental and Occupational Health

Cite this

Carness, LT. J. M., Russell, J. L., E Lima, R. M., Navarro, L. H. C., & Kramer, G. (2012). Fluid resuscitation using the intraosseous route: Infusion with lactated Ringer's and hetastarch. Military Medicine, 177(2), 222-228.

Fluid resuscitation using the intraosseous route : Infusion with lactated Ringer's and hetastarch. / Carness, LT Jeffrey M; Russell, Jennifer L.; E Lima, Rodrigo M.; Navarro, Lais H C; Kramer, George.

In: Military Medicine, Vol. 177, No. 2, 02.2012, p. 222-228.

Research output: Contribution to journalArticle

Carness, LTJM, Russell, JL, E Lima, RM, Navarro, LHC & Kramer, G 2012, 'Fluid resuscitation using the intraosseous route: Infusion with lactated Ringer's and hetastarch', Military Medicine, vol. 177, no. 2, pp. 222-228.
Carness, LT Jeffrey M ; Russell, Jennifer L. ; E Lima, Rodrigo M. ; Navarro, Lais H C ; Kramer, George. / Fluid resuscitation using the intraosseous route : Infusion with lactated Ringer's and hetastarch. In: Military Medicine. 2012 ; Vol. 177, No. 2. pp. 222-228.
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AB - Objective: The effectiveness of the intraosseous (IO) route for fluid resuscitation remains uncertain. This study compares IO infusion rates and estimated volume expansion using clinically relevant infusion pressures with lac-tated Ringer's (LR) and hetastarch (HES). Methods: IO needles were placed in the sternum or tibia for infusion of HES and LR in 8 Yorkshire pigs. Pressures were recorded at variable flow rates and linear regression used to identify flow rates at 100 and 400 mm Hg. Volume expansion was calculated for a 10-minute infusion. Results: Mean LR flow rates (mL-min -) were 24/111 (tibia-100/400 mm Hg) and 8/34 (sternum-100/400 mm Hg). The HES flow rates (mL-min -) of 10/44 (tibia-100/400 mm Hg) and 6/26 (sternum-100/400 mm Hg) were significantly lower or ~40% (p < 0.01) of the LR flow rates into the tibia and ~70% (p < 0.05) into the sternum. Mean volume expansion (mL) for a 10-min infusion of LR was estimated to be 80/369 (tibia-100/400 mm Hg) and 27/112 (sternum-100/400 mm Hg). In comparison, HES volume expansion was ~20% higher for the tibia (p > 0.05) and 110% to 120% higher for the sternum (p < 0.05). Conclusion: HES flow rates are lower than LR flow rates in the sternum and tibia of swine. Sternal infusion of HES is likely to provide greater estimated intravascular volume expansion than LR despite the lower infusion rates.

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