Resuscitation of haemorrhagic shock with normal saline vs. lactated Ringer's: effects on oxygenation, extravascular lung water and haemodynamics

• Published in: Critical care (London, England) England), 2009-01, Vol.13 (2), p.R30-R30, Article R30
• Main Authors: Phillips, Charles R, Vinecore, Kevin, Hagg, Daniel S, Sawai, Rebecca S, Differding, Jerome A, Watters, Jennifer M, Schreiber, Martin A
• Format: Article
• Language: English
• Subjects: Animals; Care and treatment; Extravascular Lung Water - drug effects; Health aspects; Hemodynamics; Hemodynamics - drug effects; Hemorrhagic shock; Hyperbaric oxygenation; Isotonic Solutions - pharmacology; Isotonic Solutions - therapeutic use; Methods; Oxygen Consumption - drug effects; Patient outcomes; Physiological aspects; Resuscitation; Resuscitation - methods; Shock, Hemorrhagic - drug therapy; Shock, Hemorrhagic - physiopathology; Sodium Chloride - pharmacology; Sodium Chloride - therapeutic use; Swine
• ISSN: 1364-8535; 1466-609X; 1364-8535
• DOI: 10.1186/cc7736

Pulmonary oedema and impairment of oxygenation are reported as common consequences of haemorrhagic shock and resuscitation (HSR). Surprisingly, there is little information in the literature examining differences in crystalloid type during the early phase of HSR regarding the development of pulmonary oedema, the impact on oxygenation and the haemodynamic response. These experiments were designed to determine if differences exist because of crystalloid fluid type in the development of oedema, the impact on oxygenation and the haemodynamic response to fluid administration in early HSR. Twenty anaesthetised swine underwent a grade V liver injury and bled without resuscitation for 30 minutes. The animals were randomised to receive, in a blinded fashion, either normal saline (NS; n = 10) or lactated Ringer's solution (LR; n = 10). They were then resuscitated with study fluid to, and maintained at, the preinjury mean arterial pressure (MAP) for 90 minutes. Extravascular lung water index (EVLWI) began to increase immediately with resuscitation with both fluid types, increasing earlier and to a greater degree with NS. A 1 ml/kg increase in EVLWI from baseline occurred after administartion of (mean +/- standard error of the mean) 68.6 +/- 5.2 ml/kg of normal saline and 81.3 +/- 8.7 ml/kg of LR (P = 0.027). After 150 ml/kg of fluid, EVLWI increased from 9.5 +/- 0.3 ml/kg to 11.4 +/- 0.3 ml/kg NS and from 9.3 +/- 0.2 ml/kg to 10.8 +/- 0.3 ml/kg LR (P = 0.035). Despite this, oxygenation was not significantly impacted (Delta partial pressure of arterial oxygen (PaO2)/fraction of inspired oxygen (FiO2)