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Initial administration of hydroxyethyl starch vs lactated Ringer after liver trauma in the pig
M Zaar1, B Lauritzen, N H Secher
1Department of Anaesthesia, Faculty of Health Sciences, University of Copenhagen, Denmark. morten.zaar@biology.au.dk
British Journal of Anaesthesia
|December 17, 2008
Summary
Hydroxyethyl starch (HES) expanded intravascular volume more than lactated Ringer's (RL) post-trauma. However, HES worsened bleeding, indicating volume expansion alone does not stabilize circulation after hemorrhage.
Area of Science:
- Trauma care
- Resuscitation strategies
- Hemorrhagic shock management
Background:
- Post-trauma resuscitation often involves fluid administration to restore circulatory volume.
- Hydroxyethyl starch (HES) 130/0.4 is a large intravascular volume expander.
- Lactated Ringer's (RL) solution is a standard resuscitation fluid.
Purpose of the Study:
- To compare the circulatory effectiveness of HES versus RL in a post-trauma setting.
- To evaluate the impact of these fluids on bleeding and survival after liver injury.
Main Methods:
- A liver injury model was established in 14 pigs.
- Fluid resuscitation was simulated in three phases, with initial administration of either HES or RL, followed by HES for all.
- Hemodynamic parameters, blood loss, oxygen uptake, and survival were monitored.
Main Results:
- HES demonstrated a greater intravascular volume expansion effect (115%) compared to RL (76%).
- Initial HES administration provoked uncontrolled hemorrhage, leading to significantly higher blood loss (2455 ml) versus RL (311 ml).
- Survival rates were lower in the HES group (3/7) compared to the RL group (7/7), with oxygen uptake also compromised in the HES group.
Conclusions:
- While HES offers superior volume expansion, its administration post-trauma can exacerbate bleeding.
- Prioritizing volume expansion with HES did not lead to circulatory stabilization in this model.
- RL administration was associated with attenuated bleeding and improved survival, suggesting a more favorable initial resuscitation strategy in this context.
