Early vasopressin improves short-term survival after pulmonary contusion

Ara J. Feinstein, Stephen M. Cohn, David R. King, Masamitsu Sanui, Kenneth G. Proctor, Kimberly A. Davis, Krishnan Raghavendran, Richard P. Dutton

Research output: Contribution to journalArticle

34 Scopus citations

Abstract

Arginine vasopressin (AVP) is a promising treatment for several types of irreversible shock, but its therapeutic potential has not been examined after severe chest trauma. Two series of experiments were performed to fill this gap Methods: Series 1: anesthetized, mechanically-ventilated pigs (n = 20, 29 ± 1 kg) received a blast to the chest, followed by a " controlled" arterial hemorrhage to a mean arterial pressure (MAP) <30 mm Hg. At 20 minutes, a 10 mL/kg normal saline (NS) bolus was followed by either 0.1 U/kg AVP bolus or NS, in randomized, blinded fashion. From 30-300 minutes, either AVP (0.4U/ kg/hr plus NS) or NS alone was infused as needed to MAP>70 mm Hg. Series 2: Swine (n = 15) received the chest injury followed by partial left hepatectomy to produce "uncontrolled" hemorrhage. Resuscitation was the same as in series 1 Results: The blast created bilateral parenchymal contusions (R > L), hemo/ pneumothorax and progressive cardiopulmonary distress. In Series 1, there were 3/20 deaths before randomization, 0/8 deaths after resuscitation with AVP versus 4/9 deaths with NS (p = 0.029). In surviving animals, with AVP versus NS, fluid requirements and peak airway pressures were lower while P/F was higher (all p < 0.05). In Series 2, with uncontrolled hemorrhage, there were 5/15 deaths before randomization. Upon resuscitation with AVP versus NS, survival time and blood loss were both improved, but the differences did not reach statistical significance Conclusions: After severe chest trauma with controlled hemorrhage, early AVP decreased mortality, reduced fluid requirements and improved pulmonary function. With uncontrolled hemorrhage, early AVP did not increase the risk for bleeding.

Original languageEnglish (US)
Pages (from-to)876-883
Number of pages8
JournalJournal of Trauma - Injury, Infection and Critical Care
Volume59
Issue number4
DOIs
StatePublished - Oct 1 2005

Keywords

  • Hemorrhage
  • Liver
  • Swine

ASJC Scopus subject areas

  • Surgery

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    Feinstein, A. J., Cohn, S. M., King, D. R., Sanui, M., Proctor, K. G., Davis, K. A., Raghavendran, K., & Dutton, R. P. (2005). Early vasopressin improves short-term survival after pulmonary contusion. Journal of Trauma - Injury, Infection and Critical Care, 59(4), 876-883. https://doi.org/10.1097/01.ta.0000187654.24146.22