Merck
  • Home
  • Search Results
  • Uncontrolled hemorrhagic shock results in a hypercoagulable state modulated by initial fluid resuscitation regimens.

Uncontrolled hemorrhagic shock results in a hypercoagulable state modulated by initial fluid resuscitation regimens.

The journal of trauma and acute care surgery (2013-08-14)
Gordon M Riha, Nicholas R Kunio, Philbert Y Van, Igor Kremenevskiy, Ross Anderson, Gregory J Hamilton, Jerome A Differding, Martin A Schreiber
ABSTRACT

Previous studies have shown large-volume resuscitation modulates coagulopathy and inflammation. Our objective was to analyze the effects of initial bolus fluids used in military and civilian settings on coagulation and inflammation in a prospective, randomized, blinded trial of resuscitation of uncontrolled hemorrhage. Fifty swine were anesthetized, intubated, and ventilated and had monitoring lines placed. A Grade V liver injury was performed followed by 30 minutes of hemorrhage. After 30 minutes, the liver was packed, and randomized fluid resuscitation was initiated during a 12-minute period with 2 L of normal saline, 2 L of lactated Ringer's solution, 250 mL of 7.5% saline with 3% Dextran, 500 mL of Hextend, or no fluid (NF). Animals were monitored for 2 hours after injury. Thrombelastograms (TEGs), prothrombin time (PT), partial thromboplastin time, fibrinogen as well as serum interleukin 6, interleukin 8, and tumor necrosis factor α levels were drawn at baseline and after 1 hour and 2 hours. The NF group had less posttreatment blood loss compared with other groups (p < 0.01). Blood loss was similar in the other groups. TEG R values in each group decreased from baseline at 1 and 2 hours (p < 0.02). The groups receiving 2 L of normal saline, 250 mL of 7.5% saline with 3% Dextran, or 500 mL of Hextend had lower TEG maximum amplitude values compared with NF group (p < 0.02). All fluids except lactated Ringer's solution resulted in significant increases in PT compared with NF, whereas all fluids resulted in significant decreases in fibrinogen compared with NF (p < 0.02). Fluid resuscitation groups as well as NF group demonstrated significant increases in inflammatory cytokines from baseline to 1 hour and baseline to 2 hours. There were no significant differences in inflammatory cytokines between groups at 2 hours. Withholding fluid resulted in the least significant change in PT, fibrinogen, and maximum amplitude and in the lowest posttreatment blood loss. Resuscitation with different initial fluid resuscitation strategies did not result in increased proinflammatory mediators compared with animals that did not receive fluid.

MATERIALS
Product Number
Brand
Product Description

Sigma-Aldrich
Sodium chloride solution, 0.85%
Sigma-Aldrich
Sodium chloride, AnhydroBeads, −10 mesh, 99.99% trace metals basis
Sigma-Aldrich
Sodium chloride, AnhydroBeads, −10 mesh, 99.999% trace metals basis
Supelco
Dextran, analytical standard, for GPC, 270,000
Supelco
Dextran, analytical standard, for GPC, 670,000
Sigma-Aldrich
Sodium chloride, random crystals, optical grade, 99.9% trace metals basis
Sigma-Aldrich
Sodium chloride, 99.999% trace metals basis
Supelco
Dextran, analytical standard, for GPC, 150,000
Supelco
Dextran, analytical standard, for GPC, 80,000
Supelco
Dextran, analytical standard, for GPC, 410,000
Sigma-Aldrich
Dextran from Leuconostoc spp., Mr 15,000-25,000
Supelco
Dextran, analytical standard, for GPC, 5,000
Sigma-Aldrich
Dextran from Leuconostoc spp., Mr ~40,000
Sigma-Aldrich
Dextran from Leuconostoc spp., Mr ~2,000,000
Sigma-Aldrich
Dextran from Leuconostoc spp., Mr ~6,000
Sigma-Aldrich
Dextran from Leuconostoc spp., Mr ~70,000
Sigma-Aldrich
Dextran from Leuconostoc spp., Mr 450,000-650,000
Sigma-Aldrich
Dextran, enzymatic synth.
Sigma-Aldrich
Dextran from Leuconostoc mesenteroides, Mr ~60,000
Sigma-Aldrich
Dextran from Leuconostoc mesenteroides, Mr ~200,000
Supelco
Dextran from Leuconostoc mesenteroides, analytical standard, for GPC, Mw 12,000
Supelco
Dextran from Leuconostoc mesenteroides, analytical standard, for GPC, Mw 1,000
Sigma-Aldrich
Sodium chloride solution, 0.9% in water, BioXtra, suitable for cell culture
Sigma-Aldrich
Sodium chloride, tablet
Sigma-Aldrich
Sodium chloride, for molecular biology, DNase, RNase, and protease, none detected, ≥99% (titration)
Sigma-Aldrich
Sodium chloride, BioXtra, ≥99.5% (AT)
Sigma-Aldrich
Sodium chloride solution, 5 M in H2O, BioReagent, for molecular biology, suitable for cell culture
Sigma-Aldrich
Sodium chloride solution, 5 M
Sigma-Aldrich
Dextran from Leuconostoc mesenteroides, average mol wt 48,000-90,000
Sigma-Aldrich
Dextran from Leuconostoc mesenteroides, average mol wt 9,000-11,000