Volume replacement with lactated ringer's or 3% hypertonic saline solution during combined experimental hemorrhagic shock and traumatic brain injury

Fernando Campos Gomes Pinto, Antonio Capone-Neto, Ricardo Prist, Mauricio Rocha E Silva, Luiz F. Poli-de-Figueiredo, Nicholas Namias, Takehiko Tarui, Joseph M. Van De Water

Research output: Contribution to journalArticlepeer-review

37 Scopus citations

Abstract

Background: The devastating effects of hypotension on head-trauma-related mortality are well known. This study evaluates the systemic and cerebral hemodynamic responses to volume replacement with 3% hypertonic saline (HSS) or lactated Ringer's solution (LR), during the acute phase of hemorrhagic shock (HS) associated with traumatic brain injury (TBI). Methods: Fifteen dogs were assigned to one of three groups (n = 5, each) according to the volume replacement protocol, infused after TBI (brain fluid percussion, 4 atm) and epidural balloon to an intracranial pressure (ICP) higher than 20 mm Hg and HS, induced by blood removal to a mean arterial pressure (MAP) of 40 mm Hg in 5 minutes: Group HS+TBI+HSS (8 mL/kg of 3% HSS), HS+TBI+LR (16 mL/kg LR), and Group HS+TBI (controls, no fluids). We simulated treatment during prehospital and early hospital admission. Groups HS+ TBI and HS+TBI+LR received shed blood infusion to a target hematocrit of 30%. Measurements included shed blood volume, fluid volume infused to restore MAP, MAP, cardiac output, cerebral perfusion pressure, cerebral and systemic lactate, and oxygen extraction ratios. Results: Fluid replacement with HSS 3% or LR promoted major hemodynamic benefits over control animals without luids. Cerebral perfusion pressure was higher than controls and similar between treated groups; however, HSS 3% infusion was associated with lower ICP during the "early hospital phase" and a higher serum sodium and osmolarity. Conclusion: In the event of severe head trauma and hemorrhagic shock, the use of HSS 3% and larger volumes of LR promote similar systemic and cerebral hemodynamic benefits. However, a lower ICP was observed after HSS 3% than after LR.

Original languageEnglish (US)
Pages (from-to)758-764
Number of pages7
JournalJournal of Trauma - Injury, Infection and Critical Care
Volume60
Issue number4
DOIs
StatePublished - Apr 2006
Externally publishedYes

Keywords

  • Hemorrhagic shock
  • Hypertonic saline solution
  • Lactated Ringer's solution
  • Traumatic brain injury

ASJC Scopus subject areas

  • Surgery

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