Abstract
Objective: To compare the resuscitative effects of Ringer’s lactate (RL), RL combined with hydroxyethyl starch (HES) 130/0.4 6% (RLH), and RL combined with gelofusine (RLG) on blood lactate and neutrophil gelatinase-associated lipocalin (NGAL) levels in patients with hemorrhagic shock.
Design: A quantitative, analytical, prospective cohort study.
Setting: A tertiary care hospital operating room setting where patients experienced intraoperative hemorrhagic shock.
Patients and participants: Patients who met clinical criteria for hemorrhagic shock and received fluid resuscitation with RL, RLH, or RLG. Consecutive sampling was applied, with baseline and 12-hour post-resuscitation measurements collected.
Interventions: Fluid resuscitation using one of three regimens: RL alone, RL+HES 130/0.4 6% with a 2:1 ratio, or RL+gelofusine with a 2:1 ratio.
Measurements and results: Blood lactate and NGAL were measured before (T0) and 12 hours after resuscitation (T1). All three regimens produced significant reductions in lactate and NGAL levels (p<0.001). The most significant decrease in lactate was observed in the RL group (-3.30±0.88 mmol/l), followed by RLG (-3.10±0.57 mmol/l) and RLH (-2.61±0.91 mmol/l), with no statistically significant difference among groups (p=0.067). NGAL also declined significantly across all groups, with RL showing the largest decrease (-6288.63±14218.55 ng/ml), followed by RLG (-2030.73±2383.25 ng/ml) and RLH (-978.84±765.31 ng/ml). However, intergroup differences were not significant (p=0.655).
Conclusions: RL, RLH, and RLG were all effective in improving microcirculatory markers in hemorrhagic shock, as reflected by significant decreases in lactate and NGAL levels. These findings indicated that all three strategies offered comparable biochemical benefits during early resuscitation from hemorrhagic shock.
Rachmad Ismail, Muhammad Rum, Faisal Muchtar, Haizah Nurdin, Syamsul Hilal Salam, Andi Adil
