Fluid resuscitation in canine traumatic-hemorrhagic shock: long-term comparison of hydroxyethyl starch vs. Ringer's...

In 16 anesthetized foxhounds a traumatic-hemorrhagic shock was performed. Following shock the dogs were randomized to treatment with autologous blood and either hydroxyethyl starch (HES, 450/0.5) or Ringer's lactate (RL). The animals were monitored for 24 h after treatment. The maintenance of normal cardiac output and left atrial pressure at pre-shock levels required 4.8 times more RL than HES. Extravascular lung water (EVLW) increased (p less than 0.01) with both treatment modalities without amelioration during the 24-hour observation period. No difference in EVLW was observed despite the higher infusion rate in the RL-group. Fluid loss into abdominal cavity, however was significantly lower (p less than 0.01) in the HES-treated animals. Albumin extravasation, on the other hand, was more pronounced (p less than 0.01) in the RL-group and, moreover, albumin redelivery by lymph was decreased (p less than 0.05). On the basis of this study, both fluid modalities appear to be equally effective in resuscitation from traumatic-hemorrhagic shock without interfering with pulmonary function and ARDS. The importance that the tissue albumin accumulation ranks for final outcome from shock, however, requires further investigation.