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Small-volume resuscitation with hypertonic saline dextran solution.

G C Kramer, P R Perron, D C Lindsey

    Surgery
    |August 1, 1986
    PubMed
    Summary
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    Small-volume hypertonic saline dextran effectively restores cardiovascular and metabolic function after hemorrhage. This resuscitation method significantly reduces the total fluid volume required compared to normal saline.

    Area of Science:

    • Emergency Medicine
    • Physiology
    • Resuscitation Science

    Background:

    • Hemorrhage necessitates rapid fluid resuscitation to restore cardiovascular function.
    • Small-volume hypertonic resuscitation is a proposed method for pre-hospital fluid management.
    • Evaluating the efficacy of hypertonic saline dextran in a controlled hemorrhage model is crucial.

    Purpose of the Study:

    • To assess the cardiovascular, metabolic, and neurohumoral responses to small-volume hypertonic saline dextran resuscitation following prolonged hemorrhage.
    • To compare the effectiveness of hypertonic saline dextran with normal saline in restoring physiological parameters.

    Main Methods:

    • Adult sheep underwent controlled hemorrhage to a mean arterial pressure of 50 mm Hg for 3 hours.
    • Treatment involved a single bolus infusion of hypertonic saline dextran (200 ml) or normal saline (control).

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  • Physiological parameters including blood pressure, cardiac output, oxygen consumption, and urine output were monitored during a 30-minute simulated transport period.

    • Main Results:

    • Hypertonic saline dextran rapidly restored blood pressure and cardiac output within 2 minutes.
    • Cardiac output, oxygen consumption, and urine output remained elevated above baseline with hypertonic saline dextran.
    • Normal saline resulted in only a minor increase in blood pressure and no improvement in cardiac output or oxygen consumption.
    • Subsequent resuscitation with lactated Ringer's solution required significantly less volume in the hypertonic saline dextran group.

    Conclusions:

    • Small-volume hypertonic saline dextran (approximately 4 ml/kg) effectively restores cardiovascular and metabolic function for at least 30 minutes post-hemorrhage.
    • Hypertonic saline dextran resuscitation significantly reduces overall fluid resuscitation volume requirements.
    • This approach offers a promising strategy for initial management of hemorrhagic shock in pre-hospital settings.