Fluid resuscitation, hemostasis, and transfusion is essential in care of hemorrhagic shock. Although estimation of the residual blood volume is crucial, the standard measuring methods are impractical or unsafe. Vital signs, central venous or pulmonary artery pressures are inaccurate. We hypothesized that the residual blood volume for acute, non-ongoing hemorrhage was calculable using serial hematocrit measurements and the volume of isotonic solution infused. Blood volume is the sum of volumes of red blood cells and plasma. For acute, non-ongoing hemorrhage, red blood cell volume would not change. A certain portion of the isotonic fluid would increase plasma volume. Mathematically, we suggest that the residual blood volume after acute, non-ongoing hemorrhage might be calculated as 0·25N/[(Hct1/Hct2)-1], where Hct1 and Hct2 are the initial and subsequent hematocrits, respectively, and N is the volume of isotonic solution infused. In vivo validation and modification is needed before clinical application of this model.
Blood Volume ; Hematocrit ; Humans ; Isotonic Solutions/*therapeutic use ; *Models, Theoretical ; Shock, Hemorrhagic/*prevention & control/*therapy

Parkland formula is the most widely used resuscitation formula in burn care. However, a growing number of disputes have been raised along with the development of medical technology, among which its total volume and composition of the fluid are the two foci. Firstly, Parkland formula may lead to an untoward phenomenon nicknamed "fluid creep", which may lead to complications such as abdominal compartment syndrome. Secondly, along with the deeper understanding of how permeability of blood vessels changes after burn injury, colloid is recommended to be given after the third 8 h post-burn. Additionally, controversy exists in the choice of different colloid solutions. The safety of different colloid solutions remains to be further elucidated. This article will deal with all of the above-mentioned problems.
Burns ; physiopathology ; therapy ; Fluid Therapy ; methods ; Humans ; Isotonic Solutions ; therapeutic use ; Resuscitation ; methods ; Treatment Outcome

Fluid resuscitation is an essential intervention in critically ill patients, and its ultimate goal is to restore tissue perfusion. Critical illnesses are often accompanied by glycocalyx degradation caused by inflammatory reactions, hypoperfusion, shock, and so forth, leading to disturbed microcirculatory perfusion and organ dysfunction. Therefore, maintaining or even restoring the glycocalyx integrity may be of high priority in the therapeutic strategy. Like drugs, however, different resuscitation fluids may have beneficial or harmful effects on the integrity of the glycocalyx. The purpose of this article is to review the effects of different resuscitation fluids on the glycocalyx. Many animal studies have shown that normal saline might be associated with glycocalyx degradation, but clinical studies have not confirmed this finding. Hydroxyethyl starch (HES), rather than other synthetic colloids, may restore the glycocalyx. However, the use of HES also leads to serious adverse events such as acute kidney injury and bleeding tendencies. Some studies have suggested that albumin may restore the glycocalyx, whereas others have suggested that balanced crystalloids might aggravate glycocalyx degradation. Notably, most studies did not correct the effects of the infusion rate or fluid volume; therefore, the results of using balanced crystalloids remain unclear. Moreover, mainly animal studies have suggested that plasma may protect and restore glycocalyx integrity, and this still requires confirmation by high-quality clinical studies.
Animals ; Colloids ; Crystalloid Solutions/therapeutic use* ; Fluid Therapy ; Glycocalyx ; Humans ; Hydroxyethyl Starch Derivatives ; Isotonic Solutions ; Microcirculation ; Resuscitation

OBJECTIVETo investigate the effect of hyperoxic Ringer's solution on inhalation injury given at early postburn stage in rabbit.

METHODSSeventy-seven rabbits were randomly divided into four groups, i.e. A (normal control, n = 5, without injury), B (n = 24, with Ringer's solution infusion for 10 days after injury), C (n = 24, with hyperoxic Ringer's solution infusion for 10 days after injury) and D (n = 24, without treatment after injury) groups. The rabbits in B, C and D groups were observed on 1 post injury day (PID), 2 PID, 3 PID, 5 PID, 7 PID and 10 PID, with 4 in each time points. The vital signs and survival rate were observed and the blood gas analysis, the WBC and PMN in the peripheral blood, ratio of wet/dry weight (W/D) of the lung tissue, the MDA, SOD contents in the pulmonary tissue, and the pulmonary pathomorphology were determined by corresponding methods.

RESULTSThe respiratory rate of the rabbits increased postburn, which was accompanied with gasping breath, flapping of nasal alae, frequent cough, and increased buccal and nasal secretion. Dry and wet rales were heard in the lungs after injury. The survival rate in D, B and C groups was 13.3%, 27.8% and 65.6%, respectively. Metabolic acidosis was identified in these groups by blood gas analysis. The indices of PaCO2, WBC, PMN, W/D, MDA in B, C and D groups were higher than those in A group in the order of D > B > C > A groups. While the pH, PaO2 value and SOD content in D group were lower than those in A group in the order of D < B < C < A groups (P < 0.05). Pathomorphological examination revealed that pulmonary volume increased after the injury with microscopic inflammatory changes in pulmonary tissue in B, C and D groups. While the extent and degree of injury in C group after the treatment of hyperoxic Ringer's solution were evidently less severe than those in other groups.

CONCLUSIONEarly administration of hyperoxic Ringer's solution during the early postburn stage could be beneficial to the management of inhalation injury.

Animals ; Blood Gas Analysis ; Burns, Inhalation ; therapy ; Disease Models, Animal ; Fluid Therapy ; Isotonic Solutions ; therapeutic use ; Oxygen ; administration & dosage ; Rabbits

OBJECTIVETo explore the dynamic postburn changes in rat hepatic function and the effects of hyperoxic Ringer's solution resuscitation on the function.

METHODSOne hundred and ninety Wistar rats of both sexes with body weight of 250 - 300 g were employed as the model and were divided into 6 groups as A, B, C, D, E and F groups as follows: normal control (A, n = 10), early resuscitation with Ringer's solution (B, n = 40), delayed resuscitation with Ringer's solution (C, n = 30), early resuscitation with hyperoxic Ringer's solution (D, n = 40), delayed hyperoxic Ringer's solution resuscitation (E, n = 30) and burn control (F, n = 40). Blood samples were drawn from the injured rats under anesthesia at 6, 12, 24 and 48 postburn hours (PBHs), and the serum contents of ALT, AST and MDA in these blood samples were determined. Hepatic tissue samples were also harvested at the same time and served histologically.

RESULTSThe plasma ALT level at 6 PBH in all groups was higher than that in A group (P < 0.05). There was significant difference of plasma ALT levels between hyperoxic Ringer's solution treatment group an other treatment groups (P < 0.05). And there was evident difference of plasma ALT levels between hyperoxic Ringer's solution treatment groups and other treatment groups (P < 0.05). The dynamic change in plasma AST was almost similar to that of ALT. The plasma MDA level was increased obviously after injury, especially in F group (highest level). Furthermore, the MDA level in C group was higher than that in B group. The plasma MDA levels in D and E groups were evidently lower than that in all other groups (P < 0.05). It was revealed by histological examination that there were different degrees of degeneration an necrosis of hepatocytes during early postburn stage, but less so in D group.

CONCLUSIONFluid resuscitation during early postburn stage with hyperoxic Ringer's solution could inhibit the production of oxygen free radicals and blunt lipid peroxidation, and it could also enhance the host tolerance to hypoxia and prevent hepatocytes from injury, thus hepatic function was protected.

Animals ; Burns ; metabolism ; therapy ; Fluid Therapy ; Hepatocytes ; drug effects ; pathology ; Isotonic Solutions ; therapeutic use ; Liver ; metabolism ; pathology ; Oxygen ; administration & dosage ; Rats ; Rats, Wistar ; Shock, Traumatic ; metabolism ; therapy

BACKGROUNDThe value of artificial colloids in treating patients with liver disease is controversial. The effects of intravascular volume replacement regimens on liver function secondary to alteration of the postoperative inflammatory response are not known. In this study, we evaluated the effects of different volume replacement regimens in hepatocellular carcinoma patients undergoing hepatectomy to clarify whether albumin administration can be replaced by other volume replacement products.

METHODSNinety consecutive hepatocellular carcinoma patients scheduled for hepatectomy were prospectively randomized to receive 20% human albumin (HA), 6% hydroxyethyl starch (HES) or lactated Ringer's solution (LR) for postoperative volume replacement. Hemodynamic, liver function and inflammatory response parameters were recorded on postoperative days one, three, and five throughout the investigation period.

RESULTSSignificantly less volume was required in the HA and the HES groups. Although patients in all groups had similar baseline values, the plasma osmolality was significantly higher in the HA and HES groups. Total bilirubin (TB), alanine aminotransferase (ALT), and aspartate aminotransferase (AST) increased from baseline in all groups, and did not differ significantly between groups. C-reactive protein (CRP) was significantly lower in the HES group compared with the other groups.

CONCLUSIONSIn hepatocellular carcinoma patients undergoing hepatectomy, HA can be replaced by HES or LR in well selected patients. Hemodynamic stability, liver function, and postoperative clinical outcomes could be equivalently achieved in the HES group; also, HES may exert more favorable effects on the acute phase response.

Adolescent ; Adult ; Aged ; Albumins ; therapeutic use ; Carcinoma, Hepatocellular ; surgery ; Female ; Hemodynamics ; Hepatectomy ; methods ; Humans ; Hydroxyethyl Starch Derivatives ; therapeutic use ; Isotonic Solutions ; therapeutic use ; Liver Neoplasms ; surgery ; Male ; Middle Aged ; Young Adult

OBJECTIVETo investigate the dynamic variation and action mechanism of sICAM-1 and p38 mitogen-activated protein kinases (MAPK) signal transduction in human severe trauma and resuscitation, as well as the effect of lactated Ringer's solution(LR), 7.5% sodium chloride solution(HS) and 20% albumin injection(ALB) on the incidence and mortality of multiple organ dysfunction syndrome (MODS).

METHODSSeventy-two severe trauma patients (ISS score 16-43) were divided into ISS < or = 25 and ISS > 25 groups (each group was subdivided into LR, HS and ALB groups). ELISA was used to measure the concentration of sICAM-1. Western blot was used to measure the expression of p38 MAPK.

RESULTSCompared with LR group, the transfusion volume needed for maintaining systolic blood pressure > or = 90 mm Hg was significantly decreased in HS and ALB groups (P < 0.05). Compared with the control group, the concentration of blood sICAM-1 and the expression of p38 MAPK was elevated from 4 to 48 hours after trauma in all experimental groups (P < 0.05-0.01). At 4, 12, and 24 hours, there was significant correlation between the expression of p38 MAPK and sICAM-1 (P < 0.01). Compared with LR group, sICAM-1 and p38 MAPK in HS and ALB groups were decreased (P < 0.05). sICAM-1 and p38 MAPK were significantly higher in the group of ISS > 25 than that of ISS < or = 25 (P < 0.05). MODS incidence and mortality were significantly higher in the group of ISS > 25 than that of ISS < or = 25 (P < 0.05). MODS incidence and mortality were lower in HS and ALB groups than LR group (P < 0.05).

CONCLUSIONSThe up-regulation of polymorphonuclear neutrophil-endotheliocytes (PMN-EC) adhesion may be due to the increased sICAM-1 expression during severe trauma. The up-regulation of sICAM-1 expression is correlated with the activation of p38 MAPK. During severe trauma, the levels of sICAM-1 and p38 MAPK, as well as the incidence and mortality of MODS are lower when HS and ALB are used than single lactated LR solution is used.

Adult ; Albumins ; therapeutic use ; Cell Adhesion ; Female ; Fluid Therapy ; methods ; Humans ; Intercellular Adhesion Molecule-1 ; blood ; physiology ; Isotonic Solutions ; therapeutic use ; Male ; Middle Aged ; Multiple Organ Failure ; epidemiology ; mortality ; Resuscitation ; Saline Solution, Hypertonic ; therapeutic use ; Systole ; Wounds and Injuries ; blood ; physiopathology ; therapy ; p38 Mitogen-Activated Protein Kinases ; blood ; physiology