[Early effects of 7.5% hypertonic saline solution on splanchnic perfusion after hemorrhagic shock].

Abstract

PURPOSE:

To evaluate the effects of SSH resuscitation on systemic and splanchnic hemodynamic variables in an experimental model of controlled hemorrhagic shock.

METHODS:

Ten mongrel dogs were bled (20 ml/min) to a target mean arterial pressure (MAP) of 40+/-5 mmHg. After 30 minutes of shock, animals received SSH infused in 5-minute and they were observed for 60 minutes thereafter. Systemic hemodynamics were evaluated through a Swan-Ganz and arterial catheters while gastrointestinal tract perfusion by a catheter inside the portal vein, an ultrasonic flowprobe around portal vein blood flow (PVBF) and a gastric tonometer. Splanchnic oxygen delivery and consumption, intramucosal pH and veno-arterial, portal-arterial and mucosal-arterial pCO2-gradients (D(ap-a)pCO2, D(vp-a)pCO2 e D(t-a)pCO2, respectively) were assessed.

RESULTS:

Hemorrhage (29.8+/-2.4 ml/Kg) induced significant decreases in MAP (125+/-6 to 42+/-1 mmHg), in CO (1.9+/-0.2 to 0.6+/-0.1 L/min), and PVBF (504+/-73 to 126+/-12 ml/min) while significant increases were detected in D(ap-a)pCO2 (5.3+/-0.8 to 19.9+/-1.6 mmHg) D(vp-a)pCO2 (5.4+/-1.4 to 22.6+/-2.1 mmHg) and D(t-a)pCO2 (6.1+/-1.1 to 43.8+/-7.5 mmHg). SSH infusion promoted only partial benefits in systemic and splanchnic blood flows. Reduced pCO2 gradients but fewer effects in D(t-a)pCO2 were observed.

CONCLUSION:

The SSH infusion promoted partial systemic and splanchnic hemodynamic benefits. Those benefits were especially poor at the splanchnic microcirculation, as evaluated by D(t-a)pCO2. In addition, systemic and regional oxygen-derived variables do not reflect the regional microcirculation disturbances. Gastrointestinal tonometry clearly represents a useful tool for monitoring splanchnic perfusion in patients in hemodynamic shock.

• Authors: Ruy Jorge Cruz Jr, Margareth M Yada-Langui, Alejandra Gallardo Garrido, Luiz Francisco Poli de Figueiredo, Mauricio Rocha e Silva
• Journal: Acta cirurgica brasileira (Acta Cir Bras) 2006 Mar-Apr Vol. 21 Issue 2 Pg. 106-12 ISSN: 0102-8650 [Print] Brazil
• Vernacular Title: Efeitos iniciais da reposição volêmica com solução salina hipertônica a 7,5% na perfusão e oxigenação esplâncnica após choque hemorrágico.
• PMID: 16583064 (Publication Type: English Abstract, Journal Article)

Chemical References

• Saline Solution, Hypertonic

Topics

• Animals
• Dogs
• Hydrogen-Ion Concentration
• Intestinal Mucosa (blood supply)
• Reperfusion (methods)
• Resuscitation (methods)
• Saline Solution, Hypertonic (administration & dosage)
• Shock, Hemorrhagic (therapy)
• Splanchnic Circulation (drug effects)