Early and sustained vasopressin infusion augments the hemodynamic efficacy of restrictive fluid resuscitation and improves survival in a liver laceration model of hemorrhagic shock
| Autor: | Kasen Whitehouse, Kruti Shah, Alvin Baetiong, Raúl J. Gazmuri, Karla Whittinghill, Jeejabai Radhakrishnan |
|---|---|
| Rok vydání: | 2017 |
| Předmět: |
Male
Cardiac output Resuscitation Vasopressin Swine Vasopressins Sodium Hemodynamics chemistry.chemical_element Shock Hemorrhagic Sodium Chloride 030204 cardiovascular system & hematology Critical Care and Intensive Care Medicine Lacerations Random Allocation 03 medical and health sciences 0302 clinical medicine Animals Medicine Cardiac Output business.industry 030208 emergency & critical care medicine Liver Laceration Infusions Intraosseous medicine.anatomical_structure Liver chemistry Anesthesia Shock (circulatory) Vascular resistance Fluid Therapy Surgery medicine.symptom business |
| Zdroj: | Journal of Trauma and Acute Care Surgery. 82:317-327 |
| ISSN: | 2163-0755 |
| Popis: | Background Current management of hemorrhagic shock favors restrictive fluid resuscitation before control of the bleeding source. We investigated the additional effects of early and sustained vasopressin infusion in a swine model of hemorrhagic shock produced by liver laceration. Methods Forty male domestic pigs (32-40 kg) had a liver laceration inflicted with an X-shaped blade clamp, 32 received a second laceration at minute 7.5, and 24 received two additional lacerations at minute 15. Using a two-by-two factorial design, animals were randomized 1:1 to receive vasopressin infusion (0.04 U/kg per minute) or vehicle intraosseously from minute 7 until minute 240 and 1:1 to receive isotonic sodium chloride solution (12 mL/kg) intravenously at minute 30 or no fluids. Results Kaplan-Meier curves showed greater survival after vasopressin with isotonic sodium chloride solution (8/10) compared to vasopressin without isotonic sodium chloride solution (4/10), vehicle with isotonic sodium chloride solution (3/10), or vehicle without isotonic sodium chloride solution (3/10), but the differences were not statistically significant (p = 0.095 by log-rank test). However, logistic regression showed vasopressin to elicit a statistically significant benefit on survival (p = 0.042). Vasopressin augmented mean aortic pressure between 10 and 20 mm Hg without intensifying the rate of bleeding from liver laceration, which was virtually identical to that of vehicle-treated animals (33.9 ± 5.1 and 33.8 ± 4.8 mL/kg). Vasopressin increased systemic vascular resistance and reduced transcapillary fluid extravasation, augmenting the volume of isotonic sodium chloride solution retained (6.5 ± 2.7 vs 2.4 ± 2.0 mL/kg by minute 60). The cardiac output and blood flow to the myocardium, liver, spleen, kidney, small bowel, and skeletal muscle at minute 120 and minute 180 were comparable or higher in the vasopressin group. Conclusions Early and sustained vasopressin infusion provided critical hemodynamic stability during hemorrhagic shock induced by liver laceration and increased the hemodynamic efficacy of restrictive fluid resuscitation without intensifying bleeding or compromising organ blood flow resulting in improved 240-minute survival. |
| Databáze: | OpenAIRE |
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