Does the infusion rate of fluid affect rapidity of mean arterial pressure restoration during controlled hemorrhage: an experimental study - 08/07/16

Doi : 10.1016/j.ajem.2016.05.019

Claire Roger, MD, MSc ^a,^b, Benjamin Louart, MD ^a,^b, Guillaume Louart, MD ^a,^b, Xavier Bobbia, MD, MSc ^a,^b, Pierre-Geraud Claret, MD, MSc ^a, Antonia Perez-Martin, MD, PhD ^b, Laurent Muller, MD, PhD ^a,^b,^{^⁎} , Jean-Yves Lefrant, MD, PhD ^a,^b
^a Department of Anesthesiology, Emergency and Critical Care Medicine, Nimes University Hospital, 30029 Nîmes, France
^b Physiology Department, EA 2992, Faculté de Médecine de Nîmes, Université Montpellier 1, 30029 Nîmes, France

^⁎Corresponding author.

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Abstract

Objective

This study aimed to compare 2 fluid infusion rates of lactated Ringer (LR) and hydroxyethyl starch (HES) 130/0.4 on hemodynamic restoration at the early phase of controlled hemorrhagic shock.

Methods

Fifty-six anesthetized and ventilated piglets were bled until mean arterial pressure (MAP) reached 40 mm Hg. Controlled hemorrhage was maintained for 30 minutes. After this period, 4 resuscitation groups were studied (n=14 for each group): HES infused at 1 or 4mL/kg per minute or LR1 infused at 1 or 4mL/kg per minute until baseline MAP was restored. Hemodynamic assessment using PiCCO monitoring and biological data were collected.

Results

Time to restore baseline MAP ±10% was significantly lower in LR4 group (11±11 minutes) compared to LR1 group (41±25 minutes) (P=.0004). Time to restore baseline MAP ±10% was significantly lower in HES4 group (4±3 minutes) compared to HES1 (11±4 minutes) (P=.0003). Time to restore baseline MAP ±10% was significantly lower with HES vs LR whatever the infusion rate.

No statistically significant difference was observed in cardiac output, central venous saturation, extravascular lung water, and arterial lactate between 4 and 1 mL/kg per minute groups.

Conclusions

In this controlled hemorrhagic shock model, a faster infusion rate (4 vs 1mL/kg per minute) significantly decreased the time for restoring baseline MAP, regardless of the type of infused fluid. The time for MAP restoration was significantly shorter for HES as compared to LR whatever the fluid infusion rate.

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Plan

Introduction

Materials and methods

Animal preparation

Experimental protocol and times of measurements

☆	Funding: This study was funded by public grants obtained from Physiology Department, EA 2992, Faculté de Médecine de Nîmes, Université Montpellier 1, Boulevard Kennedy 30,029 Nîmes, France.