Treatment of Uncontrolled Hemorrhagic Shock After Liver... : Anesthesia & Analgesia (original) (raw)

EDITORIAL: Editorial

Treatment of Uncontrolled Hemorrhagic Shock After Liver Trauma: Fatal Effects of Fluid Resuscitation Versus Improved Outcome After Vasopressin

Raedler, Claus MD*; Voelckel, Wolfgang G. MD*; Wenzel, Volker MD*; Krismer, Anette C. MD*; Schmittinger, Christian A. DVM*; Herff, Holger BS*; Mayr, Viktoria D. MD*; Stadlbauer, Karl H. MD*; Lindner, Karl H. MD*; Königsrainer, Alfred MD†

Departments of *Anesthesiology and Critical Care Medicine and †Surgery, Leopold-Franzens-University, Innsbruck, Austria

Supported, in part, by Science project No. 7280 of the Austrian National Bank; the Austrian Science Foundation grant P14169-MED, Vienna, Austria; the Science Foundation of the Tyrolean State Hospitals, Innsbruck, Austria; and the Department of Anesthesiology and Critical Care Medicine, Leopold-Franzens-University of Innsbruck, Austria.

Accepted for publication December 26, 2003.

Address correspondence to Claus Raedler, MD, Department of Anesthesiology and Critical Care Medicine, Leopold-Franzens-University, Anichstrasse 35, 6020 Innsbruck, Austria. Address reprints to Karl H. Lindner, MD, Department of Anesthesiology and Critical Care Medicine, Leopold-Franzens-University, Anichstrasse 35, 6020 Innsbruck, Austria. Address e-mail to [email protected].

In a porcine model of uncontrolled hemorrhagic shock, we evaluated the effects of vasopressin versus an equal volume of saline placebo versus fluid resuscitation on hemodynamic variables and short-term survival. Twenty-one anesthetized pigs were subjected to severe liver injury. When mean arterial blood pressure was <20 mm Hg and heart rate decreased, pigs randomly received either vasopressin IV (0.4 U/kg; n = 7), an equal volume of saline placebo (n = 7), or fluid resuscitation (1000 mL each of lactated Ringer's solution and hetastarch; n = 7). Thirty minutes after intervention, surviving pigs were fluid resuscitated while bleeding was surgically controlled. Mean (± SEM) arterial blood pressure 5 min after the intervention was significantly (P < 0.05) higher after vasopressin than with saline placebo or fluid resuscitation (58 ± 9 versus 7 ± 3 versus 32 ± 6 mm Hg, respectively). Vasopressin improved abdominal organ blood flow but did not cause further blood loss (vasopressin versus saline placebo versus fluid resuscitation 10 min after intervention, 1343 ± 60 versus 1350 ± 22 versus 2536 ± 93 mL, respectively; P < 0.01). Seven of 7 vasopressin pigs survived until bleeding was controlled and 60 min thereafter, whereas 7 of 7 saline placebo and 7 of 7 fluid resuscitation pigs died (P < 0.01). We conclude that vasopressin, but not saline placebo or fluid resuscitation, significantly improves short-term survival during uncontrolled hemorrhagic shock.