Hypertonic acetate dextran achieves high-flow-Low-pressure resuscitation of hemorrhagic shock

T. T. Nguyen, J. B. Swischenberger, W. C. Watson, D. L. Traber, Donald Prough, David Herndon, George Kramer

Research output: Contribution to journalArticle

19 Citations (Scopus)

Abstract

Objective: For resuscitation of hemorrhagic hypovolemia, we compared the effectiveness of (1) isotonic lactated Ringer's solution (LRS), (2) 2400 mOsm of 7.5% NaCl:6% dextran 70 (HSD), and (3) 2400 mOsm of 7.9% sodium acetate:1.9% NaCl:6% dextran 70 (HAD). Design: In six randomized, blinded experiments for each solution, conscious instrumented adult sheep were hemorrhaged by removing ~1.8 L (42 ± 3 mL/kg) of blood, while maintaining the mean arterial pressure (MAP) at 50 mm Hg for 2 hours. Methods: Test solutions were infused as needed to restore the cardiac index to baseline. Results: Volume requirements with HAD (236 ± 29 mL) and HSD (244 ± 39 mL) were significantly less (p < 0.05) than LRS (3463 ± 234 mL). Mean arterial pressure was normalized with HSD and LRS, but not with HAD, which resulted in MAPs of 20 to 25 mm Hg less than baseline resulting from a reduced peripheral resistance. Oxygen delivery, however, was significantly higher with HAD during the resuscitation period. Acid-base balance (pH) and oxygen consumption were normalized within 5 minutes of infusion only with HAD. Conclusions: Small-volume infusion with HAD resulting in 'high-flow-low-pressure' resuscitation may offer unique hemodynamic and metabolic advantages for the initial treatment of hemorrhage from trauma.

Original languageEnglish (US)
Pages (from-to)602-608
Number of pages7
JournalJournal of Trauma - Injury, Infection and Critical Care
Volume38
Issue number4
StatePublished - 1995

Fingerprint

Hemorrhagic Shock
Dextrans
Resuscitation
Acetates
Pressure
Arterial Pressure
Sodium Acetate
Hypovolemia
Acid-Base Equilibrium
Oxygen Consumption
Vascular Resistance
Sheep
Hemodynamics
Hemorrhage
Oxygen
Wounds and Injuries
Ringer's solution
Ringer's lactate
Therapeutics

ASJC Scopus subject areas

  • Surgery

Cite this

Hypertonic acetate dextran achieves high-flow-Low-pressure resuscitation of hemorrhagic shock. / Nguyen, T. T.; Swischenberger, J. B.; Watson, W. C.; Traber, D. L.; Prough, Donald; Herndon, David; Kramer, George.

In: Journal of Trauma - Injury, Infection and Critical Care, Vol. 38, No. 4, 1995, p. 602-608.

Research output: Contribution to journalArticle

Nguyen, T. T. ; Swischenberger, J. B. ; Watson, W. C. ; Traber, D. L. ; Prough, Donald ; Herndon, David ; Kramer, George. / Hypertonic acetate dextran achieves high-flow-Low-pressure resuscitation of hemorrhagic shock. In: Journal of Trauma - Injury, Infection and Critical Care. 1995 ; Vol. 38, No. 4. pp. 602-608.
@article{eb56e6cf56a94ad28477e04ed7741ff9,
title = "Hypertonic acetate dextran achieves high-flow-Low-pressure resuscitation of hemorrhagic shock",
abstract = "Objective: For resuscitation of hemorrhagic hypovolemia, we compared the effectiveness of (1) isotonic lactated Ringer's solution (LRS), (2) 2400 mOsm of 7.5{\%} NaCl:6{\%} dextran 70 (HSD), and (3) 2400 mOsm of 7.9{\%} sodium acetate:1.9{\%} NaCl:6{\%} dextran 70 (HAD). Design: In six randomized, blinded experiments for each solution, conscious instrumented adult sheep were hemorrhaged by removing ~1.8 L (42 ± 3 mL/kg) of blood, while maintaining the mean arterial pressure (MAP) at 50 mm Hg for 2 hours. Methods: Test solutions were infused as needed to restore the cardiac index to baseline. Results: Volume requirements with HAD (236 ± 29 mL) and HSD (244 ± 39 mL) were significantly less (p < 0.05) than LRS (3463 ± 234 mL). Mean arterial pressure was normalized with HSD and LRS, but not with HAD, which resulted in MAPs of 20 to 25 mm Hg less than baseline resulting from a reduced peripheral resistance. Oxygen delivery, however, was significantly higher with HAD during the resuscitation period. Acid-base balance (pH) and oxygen consumption were normalized within 5 minutes of infusion only with HAD. Conclusions: Small-volume infusion with HAD resulting in 'high-flow-low-pressure' resuscitation may offer unique hemodynamic and metabolic advantages for the initial treatment of hemorrhage from trauma.",
author = "Nguyen, {T. T.} and Swischenberger, {J. B.} and Watson, {W. C.} and Traber, {D. L.} and Donald Prough and David Herndon and George Kramer",
year = "1995",
language = "English (US)",
volume = "38",
pages = "602--608",
journal = "Journal of Trauma and Acute Care Surgery",
issn = "2163-0755",
publisher = "Lippincott Williams and Wilkins",
number = "4",

}

TY - JOUR

T1 - Hypertonic acetate dextran achieves high-flow-Low-pressure resuscitation of hemorrhagic shock

AU - Nguyen, T. T.

AU - Swischenberger, J. B.

AU - Watson, W. C.

AU - Traber, D. L.

AU - Prough, Donald

AU - Herndon, David

AU - Kramer, George

PY - 1995

Y1 - 1995

N2 - Objective: For resuscitation of hemorrhagic hypovolemia, we compared the effectiveness of (1) isotonic lactated Ringer's solution (LRS), (2) 2400 mOsm of 7.5% NaCl:6% dextran 70 (HSD), and (3) 2400 mOsm of 7.9% sodium acetate:1.9% NaCl:6% dextran 70 (HAD). Design: In six randomized, blinded experiments for each solution, conscious instrumented adult sheep were hemorrhaged by removing ~1.8 L (42 ± 3 mL/kg) of blood, while maintaining the mean arterial pressure (MAP) at 50 mm Hg for 2 hours. Methods: Test solutions were infused as needed to restore the cardiac index to baseline. Results: Volume requirements with HAD (236 ± 29 mL) and HSD (244 ± 39 mL) were significantly less (p < 0.05) than LRS (3463 ± 234 mL). Mean arterial pressure was normalized with HSD and LRS, but not with HAD, which resulted in MAPs of 20 to 25 mm Hg less than baseline resulting from a reduced peripheral resistance. Oxygen delivery, however, was significantly higher with HAD during the resuscitation period. Acid-base balance (pH) and oxygen consumption were normalized within 5 minutes of infusion only with HAD. Conclusions: Small-volume infusion with HAD resulting in 'high-flow-low-pressure' resuscitation may offer unique hemodynamic and metabolic advantages for the initial treatment of hemorrhage from trauma.

AB - Objective: For resuscitation of hemorrhagic hypovolemia, we compared the effectiveness of (1) isotonic lactated Ringer's solution (LRS), (2) 2400 mOsm of 7.5% NaCl:6% dextran 70 (HSD), and (3) 2400 mOsm of 7.9% sodium acetate:1.9% NaCl:6% dextran 70 (HAD). Design: In six randomized, blinded experiments for each solution, conscious instrumented adult sheep were hemorrhaged by removing ~1.8 L (42 ± 3 mL/kg) of blood, while maintaining the mean arterial pressure (MAP) at 50 mm Hg for 2 hours. Methods: Test solutions were infused as needed to restore the cardiac index to baseline. Results: Volume requirements with HAD (236 ± 29 mL) and HSD (244 ± 39 mL) were significantly less (p < 0.05) than LRS (3463 ± 234 mL). Mean arterial pressure was normalized with HSD and LRS, but not with HAD, which resulted in MAPs of 20 to 25 mm Hg less than baseline resulting from a reduced peripheral resistance. Oxygen delivery, however, was significantly higher with HAD during the resuscitation period. Acid-base balance (pH) and oxygen consumption were normalized within 5 minutes of infusion only with HAD. Conclusions: Small-volume infusion with HAD resulting in 'high-flow-low-pressure' resuscitation may offer unique hemodynamic and metabolic advantages for the initial treatment of hemorrhage from trauma.

UR - http://www.scopus.com/inward/record.url?scp=0028946491&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0028946491&partnerID=8YFLogxK

M3 - Article

C2 - 7536851

AN - SCOPUS:0028946491

VL - 38

SP - 602

EP - 608

JO - Journal of Trauma and Acute Care Surgery

JF - Journal of Trauma and Acute Care Surgery

SN - 2163-0755

IS - 4

ER -