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Does the infusion rate of fluid affect rapidity of mean arterial pressure restoration during controlled hemorrhage

      Abstract

      Objective

      This study aimed to compare 2 fluid infusion rates of lactated Ringer (LR) and hydroxyethyl starch (HES) 130/0.4 on hemodynamic restoration at the early phase of controlled hemorrhagic shock.

      Methods

      Fifty-six anesthetized and ventilated piglets were bled until mean arterial pressure (MAP) reached 40 mm Hg. Controlled hemorrhage was maintained for 30 minutes. After this period, 4 resuscitation groups were studied (n = 14 for each group): HES infused at 1 or 4 mL/kg per minute or LR1 infused at 1 or 4 mL/kg per minute until baseline MAP was restored. Hemodynamic assessment using PiCCO monitoring and biological data were collected.

      Results

      Time to restore baseline MAP ±10% was significantly lower in LR4 group (11 ± 11 minutes) compared to LR1 group (41 ± 25 minutes) (P = .0004). Time to restore baseline MAP ±10% was significantly lower in HES4 group (4 ± 3 minutes) compared to HES1 (11 ± 4 minutes) (P = .0003). Time to restore baseline MAP ±10% was significantly lower with HES vs LR whatever the infusion rate.
      No statistically significant difference was observed in cardiac output, central venous saturation, extravascular lung water, and arterial lactate between 4 and 1 mL/kg per minute groups.

      Conclusions

      In this controlled hemorrhagic shock model, a faster infusion rate (4 vs 1 mL/kg per minute) significantly decreased the time for restoring baseline MAP, regardless of the type of infused fluid. The time for MAP restoration was significantly shorter for HES as compared to LR whatever the fluid infusion rate.
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      References

        • Norton R
        • Kobusingye O
        Injuries.
        N Engl J Med. 2013; 368: 1723-1730
        • Evans JA
        • van Wessem KJ
        • McDougall D
        • Lee KA
        • Lyons T
        • Balogh ZJ
        Epidemiology of traumatic deaths: comprehensive population-based assessment.
        World J Surg. 2010; 34: 158-163
        • Di Saverio S
        • Gambale G
        • Coccolini F
        • Catena F
        • Giorgini E
        • Ansaloni L
        • et al.
        Changes in the outcomes of severe trauma patients from 15-year experience in a Western European trauma ICU of Emilia Romagna region (1996-2010). A population cross-sectional survey study.
        Langenbeck's Arch Surg. 2014; 399: 109-126
        • Polderman KH
        • Varon J
        Do not drown the patient: appropriate fluid management in critical illness.
        Am J Emerg Med. 2015; 33: 448-450
        • Holcomb JB
        • Tilley BC
        • Baraniuk S
        • Fox EE
        • Wade CE
        • Podbielski JM
        • et al.
        Transfusion of plasma, platelets, and red blood cells in a 1:1:1 vs a 1:1:2 ratio and mortality in patients with severe trauma: the PROPPR randomized clinical trial.
        JAMA. 2015; 313: 471-482
        • Yeguiayan JM
        • Garrigue D
        • Binquet C
        • Garrigue D
        • Jacquot C
        • Martin C
        • et al.
        Medical pre-hospital management reduces mortality in severe blunt trauma: a prospective epidemiological study.
        Crit Care. 2011; 15: R34
        • Gruen RL
        • Brohi K
        • Schreiber M
        • Balogh ZJ
        • Pitt V
        • Narayan M
        • et al.
        Haemorrhage control in severely injured patients.
        Lancet. 2012; 380: 1099-1108
        • Duchesne JC
        • Heaney J
        • Guidry C
        • McSwain Jr., N
        • Meade P
        • Cohen M
        • et al.
        Diluting the benefits of hemostatic resuscitation: a multi-institutional analysis.
        J Trauma Acute Care Surg. 2013; 75: 76-82
        • Kutcher ME
        • Kornblith LZ
        • Narayan R
        • Curd V
        • Daley AT
        • Redick BJ
        • et al.
        A paradigm shift in trauma resuscitation: evaluation of evolving massive transfusion practices.
        JAMA Surg. 2013; 148: 834-840
        • Holcomb JB
        • Jenkins D
        • Rhee P
        • Johannigman J
        • Mahoney P
        • Mehta S
        • et al.
        Damage control resuscitation: directly addressing the early coagulopathy of trauma.
        J Trauma. 2007; 62: 307-310
        • Shrestha B
        • Holcomb JB
        • Camp EA
        • Camp EA
        • Del Junco DJ
        • Cotton BA
        • et al.
        Damage-control resuscitation increases successful nonoperative management rates and survival after severe blunt liver injury.
        J Trauma Acute Care Surg. 2015; 78: 336-341
        • Mizushima Y
        • Tohira H
        • Mizobata Y
        • Matsuoka T
        • Yokota J
        Fluid resuscitation of trauma patients: how fast is the optimal rate?.
        Am J Emerg Med. 2005; 23: 833-837
        • Spahn DR
        • Bouillon B
        • Cerny V
        • Coats TJ
        • Duranteau J
        • Fernández-Mondéjar E
        • et al.
        Management of bleeding and coagulopathy following major trauma: an updated European guideline.
        Crit Care. 2013; 17: R76
        • Hahn RG
        Volume effect of Ringer's solution in the blood during general anaesthesia.
        Eur J Anaesthesiol. 1998; 15: 427-432
        • Li Y
        • Zhu S
        • Hahn RG
        The kinetics of Ringer's solution in young and elderly patients during induction of general anesthesia with propofol and epidural anesthesia with ropivacaine.
        Acta Anaesthesiol Scand. 2007; 51: 880-887
        • Hahn RG
        Volume kinetics for infusion fluids.
        Anesthesiology. 2010; 113: 470-481
        • Tatara T
        • Tsunetoh T
        • Tashiro C
        Crystalloid infusion rate during fluid resuscitation from acute haemorrhage.
        Br J Anaesth. 2007; 99: 212-217
        • Chappell D
        • Jacob M
        • Hofmann-Kiefer K
        • Conzen P
        • Rehm M
        A rational approach to perioperative fluid management.
        Anesthesiology. 2008; 109: 723-740
        • Bruttig SP
        • O'Benar JD
        • Wade CE
        • Dubick MA
        Benefit of slow infusion of hypertonic saline/dextran in swine with uncontrolled aortotomy hemorrhage.
        Shock. 2005; 24: 92-96
        • Stern SA
        • Kowalenko T
        • Younger J
        • Wang X
        • Dronen SC
        Comparison of the effects of bolus vs. slow infusion of 7.5% NaCl/6% dextran-70 in a model of near-lethal uncontrolled hemorrhage.
        Shock. 2000; 14: 616-622
        • Knoferl MW
        • Angele MK
        • Ayala A
        • Cioffi WG
        • Bland KI
        • Chaudry IH
        Do different rates of fluid resuscitation adversely or beneficially influence immune responses after trauma-hemorrhage?.
        J Trauma. 1999; 46: 23-33
        • Lilly MP
        • Gala GJ
        • Carlson DE
        • et al.
        Saline resuscitation after fixed-volume hemorrhage. Role of resuscitation volume and rate of infusion.
        Ann Surg. 1992; 216: 161-171
        • Haase N
        • Perner A
        • Hennings LI
        • Siegemund M
        • Lauridsen B
        • Wetterslev M
        • et al.
        Hydroxyethyl starch 130/0.38-0.45 versus crystalloid or albumin in patients with sepsis: systematic review with meta-analysis and trial sequential analysis.
        BMJ. 2013; 346: f839
        • Zarychanski R
        • Abou-Setta AM
        • Turgeon AF
        • Houston BL
        • McIntyre L
        • Marshall JC
        • et al.
        Association of hydroxyethyl starch administration with mortality and acute kidney injury in critically ill patients requiring volume resuscitation: a systematic review and meta-analysis.
        JAMA. 2013; 309: 678-688
        • Roger C
        • Muller L
        • Deras P
        • Louart G
        • Nouvellon E
        • Molinari N
        • et al.
        Does the type of fluid affect rapidity of shock reversal in an anaesthetized-piglet model of near-fatal controlled haemorrhage? A randomized study.
        Br J Anaesth. 2014; 112: 1015-1023
        • He B
        • Xu B
        • Xu X
        • Li L
        • Ren R
        • Chen Z
        • et al.
        Hydroxyethyl starch versus other fluids for non-septic patients in the intensive care unit: a meta-analysis of randomized controlled trials.
        Crit Care. 2015; 19: 92
        • Annane D
        • Siami S
        • Jaber S
        • Martin C
        • Elatrous S
        • Declère AD
        • et al.
        Effects of fluid resuscitation with colloids vs crystalloids on mortality in critically ill patients presenting with hypovolemic shock: the CRISTAL randomized trial.
        JAMA. 2013; 310: 1809-1817
        • James MF
        • Michell WL
        • Joubert IA
        • et al.
        Resuscitation with hydroxyethyl starch improves renal function and lactate clearance in penetrating trauma in a randomized controlled study: the FIRST trial (Fluids in Resuscitation of Severe Trauma).
        Br J Anaesth. 2011; 107: 693-702
        • Liu LM
        • Ward JA
        • Dubick MA
        Effects of crystalloid and colloid resuscitation on hemorrhage-induced vascular hyporesponsiveness to norepinephrine in the rat.
        J Trauma. 2003; 54: S159-S168
        • Ewaldsson CA
        • Hahn RG
        Bolus injection of Ringer's solution and dextran 1 kDa during induction of spinal anesthesia.
        Acta Anaesthesiol Scand. 2005; 49: 152-159
        • Edelman DA
        • White MT
        • Tyburski JG
        • Wilson RF
        Post-traumatic hypotension: should systolic blood pressure of 90-109 mmHg be included?.
        Shock. 2007; 27: 134-138
        • Eastridge BJ
        • Salinas J
        • McManus JG
        • Blackburn L
        • Bugler EM
        • Cooke WH
        • et al.
        Hypotension begins at 110 mm Hg: redefining "hypotension" with data.
        J Trauma. 2007; 63 ([discussion 297-299]): 291-297
        • Cecconi M
        • De Backer D
        • Antonelli M
        • Beale R
        • Bakker J
        • Hofer C
        • et al.
        Consensus on circulatory shock and hemodynamic monitoring. Task force of the European Society of Intensive Care Medicine.
        Intensive Care Med. 2014; 40: 1795-1815
        • Bickell WH
        • Wall Jr., MJ
        • Pepe PE
        • Martin RR
        • Ginger VF
        • Allen MK
        • et al.
        Immediate versus delayed fluid resuscitation for hypotensive patients with penetrating torso injuries.
        N Engl J Med. 1994; 331: 1105-1109
        • 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
        • Capone AC
        • Safar P
        • Stezoski W
        • Tisherman S
        • Peitzman AB
        Improved outcome with fluid restriction in treatment of uncontrolled hemorrhagic shock.
        J Am Coll Surg. 1995; 180: 49-56
        • Rafie AD
        • Rath PA
        • Michell MW
        • Kirschner RA
        • Deyo DJ
        • Prough DS
        • et al.
        Hypotensive resuscitation of multiple hemorrhages using crystalloid and colloids.
        Shock. 2004; 22: 262-269
        • Vaid SU
        • Shah A
        • Michell MW
        • Rafie AD
        • Deyo DJ
        • Prough DS
        • et al.
        Normotensive and hypotensive closed-loop resuscitation using 3.0% NaCl to treat multiple hemorrhages in sheep.
        Crit Care Med. 2006; 34: 1185-1192
        • Skarda DE
        • Mulier KE
        • George ME
        • Bellman GJ
        Eight hours of hypotensive versus normotensive resuscitation in a porcine model of controlled hemorrhagic shock.
        Acad Emerg Med Off J Soc Acad Emerg Med. 2008; 15: 845-852
        • Burris D
        • Rhee P
        • Kaufmann C
        • Pikoulis E
        • Austin B
        • Eror A
        • et al.
        Controlled resuscitation for uncontrolled hemorrhagic shock.
        J Trauma. 1999; 46: 216-223
        • Mapstone J
        • Roberts I
        • Evans P
        Fluid resuscitation strategies: a systematic review of animal trials.
        J Trauma. 2003; 55: 571-589
        • Svensen CH
        • Brauer KP
        • Hahn RG
        • Uchida T
        • Traber LD
        • Traber DL
        • et al.
        Elimination rate constant describing clearance of infused fluid from plasma is independent of large infusion volumes of 0.9% saline in sheep.
        Anesthesiology. 2004; 101: 666-674
        • Rehm M
        • Haller M
        • Orth V
        • Kreimeier U
        • Jacob M
        • Dressel H
        • et al.
        Changes in blood volume and hematocrit during acute preoperative volume loading with 5% albumin or 6% hetastarch solutions in patients before radical hysterectomy.
        Anesthesiology. 2001; 95: 849-856
        • Bark BP
        • Persson J
        • Grande PO
        Importance of the infusion rate for the plasma expanding effect of 5% albumin, 6% HES 130/0.4, 4% gelatin, and 0.9% NaCl in the septic rat.
        Crit Care Med. 2013; 41: 857-866
        • Bark BP
        • Grande PO
        Infusion rate and plasma volume expansion of dextran and albumin in the septic guinea pig.
        Acta Anaesthesiol Scand. 2014; 58: 44-51
        • Hahn RG
        A haemoglobin dilution method (HDM) for estimation of blood volume variations during transurethral prostatic surgery.
        Acta Anaesthesiol Scand. 1987; 31: 572-578
        • Hahn RG
        • Drobin D
        • Stahle L
        Volume kinetics of Ringer's solution in female volunteers.
        Br J Anaesth. 1997; 78: 144-148
        • Margarson MP
        • Soni NC
        Plasma volume measurement in septic patients using an albumin dilution technique: comparison with the standard radio-labelled albumin method.
        Intensive Care Med. 2005; 31: 289-295