Zur Wirkung von Vasopressin beim unkontrollierten hämorrhagischen Schock

Vasopressor Agents or Fluid Resuscitation for the Treatment of Uncontrolled Hemorrhagic Shock, an Experimental Approach in a Porcine Liver Trauma Model The standard approach to the traumatized victim in uncontrolled hemorrhagic shock is to infuse large amounts of crystalloid and colloid fluids as early, and as rapidly as possible. The aim of this strategy is to restore intravascular volume immediately and to maintain vital organ perfusion. The results of many laboratory studies and one clinical trial question the effectiveness of this treatment recommendation and suggest that in the case of uncontrolled hemorrhage aggressive fluid resuscitation may even be harmful. Hence, we evaluated the effects of fluid resuscitation vs. epinephrine vs. vasopressin vs. saline placebo on hemodynamic variables, regional organ blood flow, and short term survival in an animal model of uncontrolled hemorrhagic shock. Twenty-eight anesthetized pigs were subjected to a severe liver injury, which resulted in an average blood loss of 35 mL/kg within 30 minutes. When mean arterial pressure was < 20 mmHg, and heart rate declined progressively, the pigs were randomly assigned to receive either 1000 mL lactated Ringer´s solution and 1000 mL of gelatine solution (n=7), or an intravenous bolus dose and continuous infusion of 45 µg/kg epinephrine (n=7), or 0.4 IU/kg Vasopressin (n=7), or saline placebo (n=7). At 30 minutes after therapeutic intervention all surviving animals have been fluid resuscitated and further blood loss has been controlled surgically. Mean ± SEM arterial blood pressure at 5 minutes after therapeutic intervention was significantly (p< 0.0001 for vasopressin vs. epinephrine vs. placebo and p< 0.04 for vasopressin vs. fluid resuscitation) higher after vasopressin vs. fluid resuscitation vs. epinephrine vs. saline placebo (58 ± 9 vs. 32 ± 6 vs. 19 ± 5 vs. 7 ± 3 mmHg; respectively). Although vasopressin improved regional organ blood flow, this effect did not result in further blood loss stemming from the liver injury (vasopressin vs. fluid resuscitation vs. epinephrine vs. saline placebo 10 minutes after intervention, 1343 ± 60 vs. 2536 ± 93 vs. 1383 ± 117 vs. 1326 ± 46 mL; respectively; p<0.0001 for fluid resuscitation vs. all other groups). In the vasopressin group, seven of seven animals survived until bleeding was surgically controlled and lived throughout the following 60 minutes. In all the other groups all animals died within the first 20 minutes after therapeutic intervention. In conclusion, vasopressin but not fluid resuscitation, epinephrine or saline placebo improved short term survival in this porcine model of severe liver trauma and uncontrolled hemorrhagic shock.

Level thesis:degree_level

thesis.doctoral

Grantor dc:publisher

Ludwig-Maximilians-Universität

Year

2003

Author dc:creator

• Schmittinger, Christian

Repository record source_url

https://edoc.ub.uni-muenchen.de/1116/

OAI identifier oai:identifier

oai:edoc.ub.uni-muenchen.de:1116