Crystalloid and colloid resuscitation of uncontrolled hemorrhagic shock following massive splenic injury

Using a standardized massive splenic injury (MSI) model of uncontrolled hem orrhagic shock we studied the effect of vigorous crystalloid or colloid flu id resuscitation on the hemodynamic response, and survival in rats. The val ue of massive fluid infusion in uncontrolled hemorrhagic shock following in tra-abdominal solid organ injury is still controversial. The effect of crys talloid and colloid infusion was studied following massive splenic, injury. The animals were randomized into six groups: group 1 (n=8) sham-operated, group 2 (n=12) MSI untreated, group 3 (n=10) MSI treated with 41.5 mL/kg Ri nger's lactate (large-volume Ringer's lactate, LVRL), group 4 (n=14) MSI tr eated with 5 mL/kg 7.5% NaCl (hypertonic saline, HTS), group 5 (n=10) MSI t reated with 7.5 mL/kg hydroxyethyl starch (HES-7.5), and group 6 (n=11) MSI treated with 15 mL/kg hydroxyethyl starch (HES-15). Following MSI mean art erial pressure (MAP) in untreated group 2 decreased from 109.1 +/-4.5 to 49 .8 +/-9.6 mmHg (P<0.001) in 60 min. Mean survival time was 132.1<plus/minus >18.7 min, and total blood loss was 30.2 +/-4.1% of blood volume. LVRL infu sion resulted in an early rise In MAP from 59.7 +/-7.3 to 90.0 +/- 11.3 mmH g (P<0.01), which then rapidly dropped to 11.7<plus/minus>4.5 mmHg (P<0.001 ) after 60 min. The mean survival time was 82.5<plus/minus>18.2 min (P<0.01 ), and total blood loss was 53.7<plus/minus>2.9% (P<0.01). Total blood loss following HTS infusion was 32.2<plus/minus>4.0% and survival time was 127. 9 +/- 19.7 min. HES-7.5 Infusion only moderately increased bleeding to 44.2 +/-3.9% (P<0.05), but mortality remained unchanged. HES-15 infusion result ed in an increase in blood loss to 47.8<plus/minus>7.1% (0.01), survival ti me dropped to 100.7 +/- 12.3 min (P<0.05). Vigorous large volume infusion o f Ringer's lactate or HES following MSI resulted in a significant increase in intra-abdominal bleeding and shortened survival time compared to untreat ed, small volume HTS, or HES-7.5-treated animals. The hemodynamic response to crystalloid or colloid infusion in blunt abdominal trauma is primarily d ependent on the severity of injury and the rate of fluid resuscitation.