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Isochloremic hypertonic solutions for severe hemorrhage

M Rocha e Silva1, G A Braga, R Prist

  • 1Research Division, Instituto do Coração, Faculdade de Medicina, Universidade de São Paulo, Brasil.

The Journal of Trauma
|August 1, 1993
PubMed
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Hypertonic dextran solutions, particularly sodium acetate (HAD), offer superior resuscitation for severe arterial bleeding compared to hypertonic NaCl. Dextran 70 as maintenance fluid showed no hemodynamic difference versus lactated Ringer's.

Area of Science:

  • Resuscitation Medicine
  • Emergency Medicine
  • Surgical Hemorrhage Control

Background:

  • Severe arterial bleeding presents significant resuscitation challenges.
  • Current treatments often involve large-volume fluid resuscitation, which can lead to dilution and other complications.
  • Novel hypertonic solutions are being investigated for improved hemodynamic support during hemorrhage.

Purpose of the Study:

  • To compare the efficacy of two isochloremic hypertonic dextran solutions (sodium acetate - HAD, and sodium lactate - HLD) against hypertonic saline dextran (HSD) for initial treatment of severe arterial bleeding.
  • To evaluate the impact of substituting dextran 70 for lactated Ringer's solution as maintenance fluid.

Main Methods:

  • Experiments utilized a pressure-driven hemorrhage (PDH) model in pentobarbital-anesthetized dogs to simulate uninterrupted arterial bleeding.

Related Experiment Videos

  • Two hypertonic (2400 mOsm/L) isochloremic dextran solutions (HAD and HLD) were compared with HSD.
  • Hemodynamic parameters, oxygen delivery, and oxygen consumption were assessed.

    • Main Results:

    • Substitution of dextran 70 for lactated Ringer's as isotonic maintenance fluid had no significant hemodynamic impact.
    • Isochloremic hypertonic solutions demonstrated similar hemodynamic resuscitative effects, outperforming hypertonic NaCl in cardiac output, oxygen delivery, and consumption.
    • Sodium acetate dextran (HAD) showed superiority over sodium lactate dextran (HLD) in improving oxygen consumption and correcting acid-base balance (pH/base excess).

    Conclusions:

    • Isochloremic hypertonic dextran solutions are effective in managing severe arterial bleeding.
    • Sodium acetate dextran (HAD) is a promising resuscitation fluid, offering better metabolic and oxygenation support compared to sodium lactate dextran (HLD) and hypertonic saline dextran (HSD).
    • Dextran 70 can be used as an isotonic maintenance fluid without adverse hemodynamic consequences.