AEMJ.Org Study Re: Fluid Resuscitation

[Guest guest]

http://www.aemj.org/cgi/content/abstract/9/4/267

Objectives: To determine the effects of delaying fluid

on the rate of

hemorrhage and hemodynamic parameters in an injury

involving the

arterial system. Methods: Twenty-one adult,

anesthetized sheep

underwent left anterior thoracotomy and transection of

the left

internal mammary artery. A chest tube was inserted

into the thoracic

cavity to provide a continuous measurement of blood

loss. The animals

were randomly assigned to one of three resuscitation

protocols: 1) no

fluid resuscitation (NR), 2) standard fluid

resuscitation (SR) begun

15 minutes after injury, or 3) delayed fluid

resuscitation (DR) begun

30 minutes after injury. All of the animals in the two

resuscitation

groups received 60 mL/kg of lactated Ringer's solution

over 30

minutes. Blood loss and hemodynamic parameters were

measured

throughout the experiment. Results: Total hemorrhage

volume (mean ±

SD) at the end of the experiment was significantly

lower (p = 0.006)

in the NR group (1,499 ± 311 mL) than in the SR group

(3,435 ± 721

mL) or the DR group (2,839 ± 1549 mL). Rate of

hemorrhage followed

changes in mean arterial pressure in all groups.

Hemorrhage

spontaneously ceased significantly sooner (p = 0.007)

in the NR group

(21 ± 14 minutes) and the DR group (20 ± 15 minutes)

than in the SR

group (54 ± 4 minutes). In the DR group, after initial

cessation of

hemorrhage, hemorrhage recurred in five of six animals

(83%) with

initiation of fluid resuscitation. Maximum oxygen (O2)

delivery in

each group after injury was as follows: 101 ± 34 mL

O2/kg/min at 45

minutes in the DR group, 51 ± 20 mL O2/kg/min at 30

minutes in the SR

group, and 35 ± 8 mL O2/kg/min at 60 minutes in the NR

group.

Conclusions: Rates of hemorrhage from an arterial

injury are related

to changes in mean arterial pressure. In this animal

model, early

aggressive fluid resuscitation in penetrating thoracic

trauma

exacerbates total hemorrhage volume. Despite

resumption of hemorrhage

from the site of injury, delaying fluid resuscitation

results in the

best hemodynamic parameters.

=====

Whenever you see an emergency vehicle responding to a call, please whisper a

little prayer to keep all that crew & all emergency response personnel safe!

EMS Orphans Education Fund is a 501 ©(3)non-profit corp. that provides post

secondary education stipends to the children of EMS personnel killed in the line

of duty. To learn more please visit: http://emsorphans.org

__________________________________________________

[Guest guest]

Interesting experiment. What were the vital signs in each group pre, post

and during the experiment? Exactly how much blood was there at each time

the vital signs were recorded? It would be interesting to see the entire

study.

Jeanne E. Amis, RN, LP

Education Director

Marfa City/County EMS

AEMJ.Org Study Re: Fluid Resuscitation

>

> http://www.aemj.org/cgi/content/abstract/9/4/267

>

> Objectives: To determine the effects of delaying fluid

> on the rate of

> hemorrhage and hemodynamic parameters in an injury

> involving the

> arterial system. Methods: Twenty-one adult,

> anesthetized sheep

> underwent left anterior thoracotomy and transection of

> the left

> internal mammary artery. A chest tube was inserted

> into the thoracic

> cavity to provide a continuous measurement of blood

> loss. The animals

> were randomly assigned to one of three resuscitation

> protocols: 1) no

> fluid resuscitation (NR), 2) standard fluid

> resuscitation (SR) begun

> 15 minutes after injury, or 3) delayed fluid

> resuscitation (DR) begun

> 30 minutes after injury. All of the animals in the two

> resuscitation

> groups received 60 mL/kg of lactated Ringer's solution

> over 30

> minutes. Blood loss and hemodynamic parameters were

> measured

> throughout the experiment. Results: Total hemorrhage

> volume (mean ±

> SD) at the end of the experiment was significantly

> lower (p = 0.006)

> in the NR group (1,499 ± 311 mL) than in the SR group

> (3,435 ± 721

> mL) or the DR group (2,839 ± 1549 mL). Rate of

> hemorrhage followed

> changes in mean arterial pressure in all groups.

> Hemorrhage

> spontaneously ceased significantly sooner (p = 0.007)

> in the NR group

> (21 ± 14 minutes) and the DR group (20 ± 15 minutes)

> than in the SR

> group (54 ± 4 minutes). In the DR group, after initial

> cessation of

> hemorrhage, hemorrhage recurred in five of six animals

> (83%) with

> initiation of fluid resuscitation. Maximum oxygen (O2)

> delivery in

> each group after injury was as follows: 101 ± 34 mL

> O2/kg/min at 45

> minutes in the DR group, 51 ± 20 mL O2/kg/min at 30

> minutes in the SR

> group, and 35 ± 8 mL O2/kg/min at 60 minutes in the NR

> group.

> Conclusions: Rates of hemorrhage from an arterial

> injury are related

> to changes in mean arterial pressure. In this animal

> model, early

> aggressive fluid resuscitation in penetrating thoracic

> trauma

> exacerbates total hemorrhage volume. Despite

> resumption of hemorrhage

> from the site of injury, delaying fluid resuscitation

> results in the

> best hemodynamic parameters.

>

>

>

>

> =====

> Whenever you see an emergency vehicle responding to a call, please whisper

a little prayer to keep all that crew & all emergency response personnel

safe!

> EMS Orphans Education Fund is a 501 ©(3)non-profit corp. that provides

post secondary education stipends to the children of EMS personnel killed in

the line of duty. To learn more please visit: http://emsorphans.org

>

> __________________________________________________

>