Normotensive and hypotensive closed-loop resuscitation using 3.0% NaCl to treat multiple hemorrhages in sheep

Sumreen U. Vaid, Alia Shah, Michael W. Michell, Abraham D. Rafie, Donald J. Deyo, Donald Prough, George Kramer

Research output: Contribution to journalArticle

25 Citations (Scopus)

Abstract

Objective: NaCl solutions (7.5%) have been reported to be effective for resuscitation in animals and trauma patients, but these solutions are not approved for use in the United States. We hypothesized that infusion of Food and Drug Administration-approved 3% NaCl provides superior cardiovascular and metabolic function while reducing the overall fluid requirement for resuscitation of hemorrhage. Our objective was to compare four groups, hypotensive and normotensive resuscitation of hemorrhage using 3% NaCl (HS) or lactated Ringer's (LR). Design: Sheep were hemorrhaged in three separate bleeds, 25 mL/kg at T0 mins and 5 mL/kg at both T50 and T70 mins. Setting: University laboratory. Subjects: Instrumented conscious sheep. Interventions: Resuscitation was started at T30 mins and continued until T180. Normotensive and hypotensive resuscitation to mean arterial pressures of 90 mm Hg and 65 mm Hg, respectively, was performed with LR or HS using a closed-loop resuscitation system. Measurements and Main Results: All four groups were successfully resuscitated to near target levels. Two animals in the hypotensive treatment protocols died during the second and third bleeding, one with the LR65 group and one with the HS65 group. Mean infused volumes were 59.9 ± 7.0 and 18.0 ± 5.9 in the LR90 and LR65 groups, respectively, and were 19.6 ± 2.2 mL/kg and 13.3 ± 5.7 mL/kg in the HS90 and HS65 treatments (p < .05; LR90 vs. each of the groups). Cardiac indexes were significantly higher with normotensive vs. hypertensive treatment. However, there was no hemodynamic advantage apparent with HS vs. LR when compared with the normotensive or hypotensive treatments. Some animals had high lactate levels (>10 mmol) with both of the hypotensive treatments and also with the HS90 treatment, while not one of the 11 LR90 treatment animals had lactate levels >8 mmol. Conclusions: Volume sparing was apparent with HS, but no hemodynamic or metabolic advantage was apparent when used for either normotensive or hypotensive resuscitation. Trends toward lower base excess values and higher occurrences of deaths only in the hypotensive treatment protocols suggest that resuscitation to a target mean arterial pressure of 65 mm Hg may be too low.

Original languageEnglish (US)
Pages (from-to)1185-1192
Number of pages8
JournalCritical Care Medicine
Volume34
Issue number4
DOIs
StatePublished - Apr 2006

Fingerprint

Resuscitation
Sheep
Hemorrhage
Clinical Protocols
Arterial Pressure
United States Food and Drug Administration
Therapeutics
Lactic Acid
Hemodynamics
Wounds and Injuries

Keywords

  • Fluid therapy
  • Hypertonic saline
  • Shock
  • Trauma

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

Cite this

Normotensive and hypotensive closed-loop resuscitation using 3.0% NaCl to treat multiple hemorrhages in sheep. / Vaid, Sumreen U.; Shah, Alia; Michell, Michael W.; Rafie, Abraham D.; Deyo, Donald J.; Prough, Donald; Kramer, George.

In: Critical Care Medicine, Vol. 34, No. 4, 04.2006, p. 1185-1192.

Research output: Contribution to journalArticle

Vaid, Sumreen U. ; Shah, Alia ; Michell, Michael W. ; Rafie, Abraham D. ; Deyo, Donald J. ; Prough, Donald ; Kramer, George. / Normotensive and hypotensive closed-loop resuscitation using 3.0% NaCl to treat multiple hemorrhages in sheep. In: Critical Care Medicine. 2006 ; Vol. 34, No. 4. pp. 1185-1192.
@article{c5faff7f6be74a949df0b10dd959993d,
title = "Normotensive and hypotensive closed-loop resuscitation using 3.0{\%} NaCl to treat multiple hemorrhages in sheep",
abstract = "Objective: NaCl solutions (7.5{\%}) have been reported to be effective for resuscitation in animals and trauma patients, but these solutions are not approved for use in the United States. We hypothesized that infusion of Food and Drug Administration-approved 3{\%} NaCl provides superior cardiovascular and metabolic function while reducing the overall fluid requirement for resuscitation of hemorrhage. Our objective was to compare four groups, hypotensive and normotensive resuscitation of hemorrhage using 3{\%} NaCl (HS) or lactated Ringer's (LR). Design: Sheep were hemorrhaged in three separate bleeds, 25 mL/kg at T0 mins and 5 mL/kg at both T50 and T70 mins. Setting: University laboratory. Subjects: Instrumented conscious sheep. Interventions: Resuscitation was started at T30 mins and continued until T180. Normotensive and hypotensive resuscitation to mean arterial pressures of 90 mm Hg and 65 mm Hg, respectively, was performed with LR or HS using a closed-loop resuscitation system. Measurements and Main Results: All four groups were successfully resuscitated to near target levels. Two animals in the hypotensive treatment protocols died during the second and third bleeding, one with the LR65 group and one with the HS65 group. Mean infused volumes were 59.9 ± 7.0 and 18.0 ± 5.9 in the LR90 and LR65 groups, respectively, and were 19.6 ± 2.2 mL/kg and 13.3 ± 5.7 mL/kg in the HS90 and HS65 treatments (p < .05; LR90 vs. each of the groups). Cardiac indexes were significantly higher with normotensive vs. hypertensive treatment. However, there was no hemodynamic advantage apparent with HS vs. LR when compared with the normotensive or hypotensive treatments. Some animals had high lactate levels (>10 mmol) with both of the hypotensive treatments and also with the HS90 treatment, while not one of the 11 LR90 treatment animals had lactate levels >8 mmol. Conclusions: Volume sparing was apparent with HS, but no hemodynamic or metabolic advantage was apparent when used for either normotensive or hypotensive resuscitation. Trends toward lower base excess values and higher occurrences of deaths only in the hypotensive treatment protocols suggest that resuscitation to a target mean arterial pressure of 65 mm Hg may be too low.",
keywords = "Fluid therapy, Hypertonic saline, Shock, Trauma",
author = "Vaid, {Sumreen U.} and Alia Shah and Michell, {Michael W.} and Rafie, {Abraham D.} and Deyo, {Donald J.} and Donald Prough and George Kramer",
year = "2006",
month = "4",
doi = "10.1097/01.CCM.0000207341.78696.3A",
language = "English (US)",
volume = "34",
pages = "1185--1192",
journal = "Critical Care Medicine",
issn = "0090-3493",
publisher = "Lippincott Williams and Wilkins",
number = "4",

}

TY - JOUR

T1 - Normotensive and hypotensive closed-loop resuscitation using 3.0% NaCl to treat multiple hemorrhages in sheep

AU - Vaid, Sumreen U.

AU - Shah, Alia

AU - Michell, Michael W.

AU - Rafie, Abraham D.

AU - Deyo, Donald J.

AU - Prough, Donald

AU - Kramer, George

PY - 2006/4

Y1 - 2006/4

N2 - Objective: NaCl solutions (7.5%) have been reported to be effective for resuscitation in animals and trauma patients, but these solutions are not approved for use in the United States. We hypothesized that infusion of Food and Drug Administration-approved 3% NaCl provides superior cardiovascular and metabolic function while reducing the overall fluid requirement for resuscitation of hemorrhage. Our objective was to compare four groups, hypotensive and normotensive resuscitation of hemorrhage using 3% NaCl (HS) or lactated Ringer's (LR). Design: Sheep were hemorrhaged in three separate bleeds, 25 mL/kg at T0 mins and 5 mL/kg at both T50 and T70 mins. Setting: University laboratory. Subjects: Instrumented conscious sheep. Interventions: Resuscitation was started at T30 mins and continued until T180. Normotensive and hypotensive resuscitation to mean arterial pressures of 90 mm Hg and 65 mm Hg, respectively, was performed with LR or HS using a closed-loop resuscitation system. Measurements and Main Results: All four groups were successfully resuscitated to near target levels. Two animals in the hypotensive treatment protocols died during the second and third bleeding, one with the LR65 group and one with the HS65 group. Mean infused volumes were 59.9 ± 7.0 and 18.0 ± 5.9 in the LR90 and LR65 groups, respectively, and were 19.6 ± 2.2 mL/kg and 13.3 ± 5.7 mL/kg in the HS90 and HS65 treatments (p < .05; LR90 vs. each of the groups). Cardiac indexes were significantly higher with normotensive vs. hypertensive treatment. However, there was no hemodynamic advantage apparent with HS vs. LR when compared with the normotensive or hypotensive treatments. Some animals had high lactate levels (>10 mmol) with both of the hypotensive treatments and also with the HS90 treatment, while not one of the 11 LR90 treatment animals had lactate levels >8 mmol. Conclusions: Volume sparing was apparent with HS, but no hemodynamic or metabolic advantage was apparent when used for either normotensive or hypotensive resuscitation. Trends toward lower base excess values and higher occurrences of deaths only in the hypotensive treatment protocols suggest that resuscitation to a target mean arterial pressure of 65 mm Hg may be too low.

AB - Objective: NaCl solutions (7.5%) have been reported to be effective for resuscitation in animals and trauma patients, but these solutions are not approved for use in the United States. We hypothesized that infusion of Food and Drug Administration-approved 3% NaCl provides superior cardiovascular and metabolic function while reducing the overall fluid requirement for resuscitation of hemorrhage. Our objective was to compare four groups, hypotensive and normotensive resuscitation of hemorrhage using 3% NaCl (HS) or lactated Ringer's (LR). Design: Sheep were hemorrhaged in three separate bleeds, 25 mL/kg at T0 mins and 5 mL/kg at both T50 and T70 mins. Setting: University laboratory. Subjects: Instrumented conscious sheep. Interventions: Resuscitation was started at T30 mins and continued until T180. Normotensive and hypotensive resuscitation to mean arterial pressures of 90 mm Hg and 65 mm Hg, respectively, was performed with LR or HS using a closed-loop resuscitation system. Measurements and Main Results: All four groups were successfully resuscitated to near target levels. Two animals in the hypotensive treatment protocols died during the second and third bleeding, one with the LR65 group and one with the HS65 group. Mean infused volumes were 59.9 ± 7.0 and 18.0 ± 5.9 in the LR90 and LR65 groups, respectively, and were 19.6 ± 2.2 mL/kg and 13.3 ± 5.7 mL/kg in the HS90 and HS65 treatments (p < .05; LR90 vs. each of the groups). Cardiac indexes were significantly higher with normotensive vs. hypertensive treatment. However, there was no hemodynamic advantage apparent with HS vs. LR when compared with the normotensive or hypotensive treatments. Some animals had high lactate levels (>10 mmol) with both of the hypotensive treatments and also with the HS90 treatment, while not one of the 11 LR90 treatment animals had lactate levels >8 mmol. Conclusions: Volume sparing was apparent with HS, but no hemodynamic or metabolic advantage was apparent when used for either normotensive or hypotensive resuscitation. Trends toward lower base excess values and higher occurrences of deaths only in the hypotensive treatment protocols suggest that resuscitation to a target mean arterial pressure of 65 mm Hg may be too low.

KW - Fluid therapy

KW - Hypertonic saline

KW - Shock

KW - Trauma

UR - http://www.scopus.com/inward/record.url?scp=33645830302&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=33645830302&partnerID=8YFLogxK

U2 - 10.1097/01.CCM.0000207341.78696.3A

DO - 10.1097/01.CCM.0000207341.78696.3A

M3 - Article

VL - 34

SP - 1185

EP - 1192

JO - Critical Care Medicine

JF - Critical Care Medicine

SN - 0090-3493

IS - 4

ER -