The Dynamics of Vascular Volume and Fluid Shifts of Lactated Ringer’s Solution and Hypertonic-Saline-Dextran Solutions Infused in Normovolemic Sheep

Infusions of hyperosmotic-hyperoncotic solutions such as hypertonic saline dextran (HSD) are used in Europe for resuscitation of traumatic shock and perioperative volume support as an adjunct to conventional isotonic crystalloids. Whereas plasma volume expansion of HSD has been measured at single ti...

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Veröffentlicht in:Anesthesia and analgesia 2001-10, Vol.93 (4), p.823-831
Hauptverfasser: Tølløfsrud, Stein, Elgjo, Geir I., Prough, Donald S., Williams, Chad A., Traber, Daniel L., Kramer, George C.
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container_issue 4
container_start_page 823
container_title Anesthesia and analgesia
container_volume 93
creator Tølløfsrud, Stein
Elgjo, Geir I.
Prough, Donald S.
Williams, Chad A.
Traber, Daniel L.
Kramer, George C.
description Infusions of hyperosmotic-hyperoncotic solutions such as hypertonic saline dextran (HSD) are used in Europe for resuscitation of traumatic shock and perioperative volume support as an adjunct to conventional isotonic crystalloids. Whereas plasma volume expansion of HSD has been measured at single time points after the intravascular volume expansion, the detailed time course of fluid shifts during and after infusions have not been reported. We compared the time course of volume expansion during and after 30-min infusions of 4 mL/kg HSD and 25 mL/kg lactated Ringer’s solution (LR) in normovolemic conscious splenectomized sheep. Peak plasma volume (Evans blue and hemoglobin dilution) expansion was similar for HSD (7.8 ± 0.9 mL/kg) and the larger sixfold volume of LR (7.2 ± 0.5 mL/kg). However, 30 min after the 30-min infusion (T60), plasma expansion remained larger after HSD (5.1 ± 0.9 mL/kg) than after LR (1.7 ± 0.6 mL/kg). Both solutions caused an equivalent diuresis. Intravascular volume expansion efficiency (VEE), defined as milliliter plasma expansion/milliliter fluid infused at 0 (T30), 30 (T60), and 60 (T90) min after infusion ended was 1.8, 1.3, and 0.8, respectively for HSD, whereas LR provided a VEE of only 0.27, 0.07, and 0.07. The relative expansion efficiency of HSD versus LR, calculated as the ratio (VEEHSD/VEELR), was 7-fold that of LR at the end of infusion T30, and 20-fold at T60, but decreased to 9-fold by T120. Intravascular volume dynamic studies of different volume expanders in animals and patients may provide anesthesiologists with a new tool for monitoring the effectiveness of fluid therapy.
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Whereas plasma volume expansion of HSD has been measured at single time points after the intravascular volume expansion, the detailed time course of fluid shifts during and after infusions have not been reported. We compared the time course of volume expansion during and after 30-min infusions of 4 mL/kg HSD and 25 mL/kg lactated Ringer’s solution (LR) in normovolemic conscious splenectomized sheep. Peak plasma volume (Evans blue and hemoglobin dilution) expansion was similar for HSD (7.8 ± 0.9 mL/kg) and the larger sixfold volume of LR (7.2 ± 0.5 mL/kg). However, 30 min after the 30-min infusion (T60), plasma expansion remained larger after HSD (5.1 ± 0.9 mL/kg) than after LR (1.7 ± 0.6 mL/kg). Both solutions caused an equivalent diuresis. Intravascular volume expansion efficiency (VEE), defined as milliliter plasma expansion/milliliter fluid infused at 0 (T30), 30 (T60), and 60 (T90) min after infusion ended was 1.8, 1.3, and 0.8, respectively for HSD, whereas LR provided a VEE of only 0.27, 0.07, and 0.07. The relative expansion efficiency of HSD versus LR, calculated as the ratio (VEEHSD/VEELR), was 7-fold that of LR at the end of infusion T30, and 20-fold at T60, but decreased to 9-fold by T120. 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Blood typing. Plasmapheresis. Apheresis</subject><subject>Coloring Agents</subject><subject>Dextrans - pharmacology</subject><subject>Diuresis - drug effects</subject><subject>Evans Blue</subject><subject>Female</subject><subject>Fluid Shifts - physiology</subject><subject>Hemodilution</subject><subject>Hemodynamics - drug effects</subject><subject>Hemoglobins - metabolism</subject><subject>Isotonic Solutions - pharmacology</subject><subject>Medical sciences</subject><subject>Osmolar Concentration</subject><subject>Ringer's Solution</subject><subject>Saline Solution, Hypertonic - pharmacology</subject><subject>Sheep</subject><subject>Transfusions. Complications. Transfusion reactions. 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Whereas plasma volume expansion of HSD has been measured at single time points after the intravascular volume expansion, the detailed time course of fluid shifts during and after infusions have not been reported. We compared the time course of volume expansion during and after 30-min infusions of 4 mL/kg HSD and 25 mL/kg lactated Ringer’s solution (LR) in normovolemic conscious splenectomized sheep. Peak plasma volume (Evans blue and hemoglobin dilution) expansion was similar for HSD (7.8 ± 0.9 mL/kg) and the larger sixfold volume of LR (7.2 ± 0.5 mL/kg). However, 30 min after the 30-min infusion (T60), plasma expansion remained larger after HSD (5.1 ± 0.9 mL/kg) than after LR (1.7 ± 0.6 mL/kg). Both solutions caused an equivalent diuresis. Intravascular volume expansion efficiency (VEE), defined as milliliter plasma expansion/milliliter fluid infused at 0 (T30), 30 (T60), and 60 (T90) min after infusion ended was 1.8, 1.3, and 0.8, respectively for HSD, whereas LR provided a VEE of only 0.27, 0.07, and 0.07. The relative expansion efficiency of HSD versus LR, calculated as the ratio (VEEHSD/VEELR), was 7-fold that of LR at the end of infusion T30, and 20-fold at T60, but decreased to 9-fold by T120. Intravascular volume dynamic studies of different volume expanders in animals and patients may provide anesthesiologists with a new tool for monitoring the effectiveness of fluid therapy.</abstract><cop>Hagerstown, MD</cop><pub>International Anesthesia Research Society</pub><pmid>11574341</pmid><doi>10.1097/00000539-200110000-00005</doi><tpages>9</tpages><oa>free_for_read</oa></addata></record>
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ispartof Anesthesia and analgesia, 2001-10, Vol.93 (4), p.823-831
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source MEDLINE; Journals@Ovid LWW Legacy Archive; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; Journals@Ovid Complete
subjects Algorithms
Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy
Animals
Biological and medical sciences
Blood Volume - physiology
Blood. Blood and plasma substitutes. Blood products. Blood cells. Blood typing. Plasmapheresis. Apheresis
Coloring Agents
Dextrans - pharmacology
Diuresis - drug effects
Evans Blue
Female
Fluid Shifts - physiology
Hemodilution
Hemodynamics - drug effects
Hemoglobins - metabolism
Isotonic Solutions - pharmacology
Medical sciences
Osmolar Concentration
Ringer's Solution
Saline Solution, Hypertonic - pharmacology
Sheep
Transfusions. Complications. Transfusion reactions. Cell and gene therapy
Urodynamics - physiology
title The Dynamics of Vascular Volume and Fluid Shifts of Lactated Ringer’s Solution and Hypertonic-Saline-Dextran Solutions Infused in Normovolemic Sheep
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