Cardiac response to fluid resuscitation from hemorrhagic shock

The choice of fluid for volume replacement in hemorrhagic shock remains controversial. This study was done to compare the cardiac hemodynamic and metabolic effects of several regimens of fluid resuscitation. Thirty nonsplenectomized dogs subjected to two hours of hemorrhagic shock were resuscitated with shed blood alone or in combination with plasma, saline solution or Ringer's lactate solution. All regimens of volume replacement were equally effective in the initial resuscitation from severe shock. Furthermore, correction of metabolic acidosis and decreased lactate production were comparable in all groups. During late resuscitation (180 to 200 minutes), cardiac hemodynamic and myocardial efficiency were significantly lower in the shed blood, plasma and saline solution groups. Our data show that Ringer's lactate solution is singularly effective in maintaining left ventricular performance despite similar preload, coronary blood flow and myocardial oxygen delivery after all regimens of volume replacement.