Abstract
Objective: The ideal resuscitative strategy in hemorrhagic shock remains a matter of debate. The standard resuscitation fluid comprises of crystalloid and colloid, such as lactated Ringer’s (LR) and hydroxyethyl starch (HES), respectively. Whether the administration of LR/HES combination can provide better microcirculatory improvements than LR alone is still unknown.
Design: Experimental analytic study comparing the effect between LR and LR/HES (200/0.5) 2:1 combination to serum lactate level in hemorrhagic shock in rabbit (Lepus nigricollis).
Setting: This study was conducted at Hasanuddin University Medical Research Center (HUMRC), Makassar, Indonesia, from July to October 2019.
Patients and participants: A total of 30 Lepus nigricollis rabbits were included in this study. Fifteen animals were allocated in each group.
Interventions: After the initiation of induced hemorrhagic shock, a hypotension period was maintained for 30 minutes using infusion of LR/HES 6% (200/0.5) 1:2 combination if mean arterial pressure (MAP) decreased more than 30% from baseline, or if there was continuous bleeding if MAP was decreased less than 20% from baseline. The animals in LR group were then resuscitated with LR, while the animals in combination group were resuscitated with LR/HES 6% (200/0.5) 2:1 30 ml/kg/hour, then continued with 3 ml/kg/hour.
Measurements and results: Serum lactate level was measured at baseline, after the initiation of hemorrhagic shock, and after resuscitation. After hemorrhage was initiated, 19 animals had a <20% decrease in MAP and 11 animals had a ≥20% decrease in MAP. There was a significant decrease in serum lactate level in both LR and combination group with <20% decrease in MAP. LR group had a significant difference in serum lactate level from before and after resuscitation, whereas in combination group, only those with <20% decrease in MAP had a significant difference. There were no significant differences in the changes of serum lactate level between both groups.
Conclusions: Resuscitation in both groups may decrease serum lactate level in hemorrhagic shock, and resuscitation with LR/HES 6% (200/0.5) 2:1 combination provided better improvement than LR alone.
Faisal Muchtar, Syafri Kamsul Arif, Andi Husni Tanra, Arif Santoso, Made Wiryana, Agussalim Bukhari, Nurpudji Astuti Daud, Hisbullah, Warsinggih, Ilhamjaya Patellongi
