The Effects of 6% Hydroxyethyl Starch-Hypertonic Saline in Resuscitation of Dogs with Hemorrhagic Shock

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dc.contributor.authorBarros, Joao M. P. [UNESP]
dc.contributor.authordo Nascimento, Paulo [UNESP]
dc.contributor.authorMarinello, Joao Luiz P. [UNESP]
dc.contributor.authorBraz, Leandro Gobbo [UNESP]
dc.contributor.authorCarvalho, Lidia R. [UNESP]
dc.contributor.authorVane, Luiz Antonio [UNESP]
dc.contributor.authorCastiglia, Yara Marcondes Machado [UNESP]
dc.contributor.authorBraz, José Reinaldo Cerqueira [UNESP]
dc.contributor.institutionUniversidade Estadual Paulista (Unesp)
dc.date.accessioned2014-05-20T13:32:01Z
dc.date.available2014-05-20T13:32:01Z
dc.date.issued2011-02-01
dc.description.abstractBACKGROUND: Hemodynamic and global oxygen transport variables have failed to reflect splanchnic hypoperfusion, resulting in a failure to recognize inadequately treated hemorrhagic shock. Volemic expansion after fluid resuscitation is essential to improve global and regional oxygen in hemorrhagic shock. We hypothesized that, in contrast to conventional plasma expanders, the smaller volemic expansion from 7.5 NaCl/6% hydroxyethyl starch (HHES) solution administration in hemorrhagic shock may provide lesser systemic oxygen delivery and gastric perfusion. We used hemorrhaged dogs to compare intravascular volume expansion and the early systemic oxygenation and gastric perfusion effects of fixed fluid bolus administration, which are usually used in clinical situations with severe hemorrhage, of HHES, lactated Ringer (LR), and 6% hydroxyethyl starch (HES) solutions.METHODS: Thirty dogs were bled (30 mL . kg(-1)) to hold mean arterial blood pressure at 40 to 50 mm Hg over 45 minutes and were resuscitated in 3 groups: LR (n = 10) at 3:1 ratio to shed blood; HES (mean molecular weight 130 kDa, degree of substitution 0.4) (n = 10) at 1:1 to shed blood; and HHES (n = 10), 4 mL . kg(-1). Intravascular volume expansion (Evans blue and hemoglobin dilution), hemodynamic, systemic oxygenation, venous-to-arterial CO(2) gradient (P (v) over bar -aco(2)), and gastric intramucosal-arterial Pco(2) gradient (Pco(2) gap) variables were measured at baseline, after 45 minutes of hemorrhage, and 5, 45, and 90 minutes after fluid resuscitation.RESULTS: HHES increased blood volume because of the high volume expansion efficiency, but intravascular volume expansion with this solution was the smallest of the solutions (P < 0.05). All 3 solutions induced a similar hemodynamic performance but HHES showed lower mixed venous Po(2) and higher systemic oxygenation extraction, P<(v)over bar>-aco(2), and Pco(2) gap than LR and HES (P < 0.05).CONCLUSIONS: In dogs submitted to pressure-guided hemorrhagic shock and fixed-volume resuscitation, the smaller intravascular volume expansion from HHES solutions provides worse recovery of systemic oxygenation and gastric perfusion compared with LR and HES solutions despite its high volume expansion efficiency, which was limited by low infused volume. (Anesth Analg 2011;112:395-404)en
dc.description.affiliationUNESP, Dept Anesthesiol, Botucatu Med Sch, BR-18618970 Botucatu, SP, Brazil
dc.description.affiliationUniv Estadual Paulista, Inst Biosci, Dept Biostat, BR-18618970 Botucatu, SP, Brazil
dc.description.affiliationUnespUNESP, Dept Anesthesiol, Botucatu Med Sch, BR-18618970 Botucatu, SP, Brazil
dc.description.affiliationUnespUniv Estadual Paulista, Inst Biosci, Dept Biostat, BR-18618970 Botucatu, SP, Brazil
dc.description.sponsorshipCoordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)
dc.description.sponsorshipFundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)
dc.description.sponsorshipIdFAPESP: 05/56112-5
dc.format.extent395-404
dc.identifierhttp://dx.doi.org/10.1213/ANE.0b013e3181f2e9b2
dc.identifier.citationAnesthesia and Analgesia. Philadelphia: Lippincott Williams & Wilkins, v. 112, n. 2, p. 395-404, 2011.
dc.identifier.doi10.1213/ANE.0b013e3181f2e9b2
dc.identifier.issn0003-2999
dc.identifier.lattes7199562550978496
dc.identifier.lattes7802830125342070
dc.identifier.urihttp://hdl.handle.net/11449/10921
dc.identifier.wosWOS:000286576000019
dc.language.isoeng
dc.publisherLippincott Williams & Wilkins
dc.relation.ispartofAnesthesia and Analgesia
dc.relation.ispartofjcr3.463
dc.relation.ispartofsjr1,472
dc.rights.accessRightsAcesso restrito
dc.sourceWeb of Science
dc.titleThe Effects of 6% Hydroxyethyl Starch-Hypertonic Saline in Resuscitation of Dogs with Hemorrhagic Shocken
dc.typeArtigo
dcterms.licensehttp://journals.lww.com/_layouts/oaks.journals/nih.aspx
dcterms.rightsHolderLippincott Williams & Wilkins
unesp.author.lattes7199562550978496
unesp.author.lattes7802830125342070
unesp.author.orcid0000-0002-1927-8729[4]
unesp.campusUniversidade Estadual Paulista (Unesp), Instituto de Biociências, Botucatupt
unesp.campusUniversidade Estadual Paulista (Unesp), Faculdade de Medicina, Botucatupt

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Artigos - Anestesiologia - FMB
Artigos - Bioestatística - IBB