The Comparison of the Effects of Pentastarch or Normal Saline Infusion on the Shock Resuscitation

Kwon, Ou Kyoung; Choi, Jong Ho; Moon, Dong Eon; Lee, Jin Ho; Hong, Sung Jin; Park, Cheol Joo

Abstract

Volume replacement is a vital therapy in patient with circulatory shock, but the type of fluid that should be infused remains in controversy. This study is designed to compare the cardiopulmonary effects of a colloid solution and a crystalloid solution in dogs subjected to severe hemorrhagic shock. Twelve dogs were bled into shock and mean arterial pressure(MAP) were maintained at 60 mmHg for 1 hour followed by further hemorrhage to 40 mmHg for additional one hour, Animals were randomized to fluid challenge with 10% pentastarch(group P) or 0.9% normal saline(group S) to restore MAP. Complete hemodynamic and blood gas parameters and plasma lactate concentration were measured at pre-shock, during shock and after resuscitation for 2 hours. Cardiac function and hemodynamic stability were restored to higher level than the control level on the completion of fluid challenge with each type of solution, but hemodynamic parameters decreased as time goes after resuscitation. Especially in group S, hemodynamic parameters decreased more significantly and rapidly than group P. Considering the relation of left ventricular stroke work index(LVSWI) and pulmonary capillary wedge pressure(PCWP), the cardiac performance was well maintained to normal level in group P during post-resuscitation period, but rapidly deteriorated in group S. There was a significant increase in intrapulmonary shunt fraction with pentastarch that was maximal on the completion of fluid challenge but which normalized over the next 1 hour. Assessment of tissue perfusion was measured by mixed venous oxygen tension(PVO2) and plasma lactate concentration. In group P, PVO. was restored to higher than the control level and maintained to the cantrol level during post-resuscitation period, but in group S, it was not restored to control level at the completion of fluid challenge, moreover after then, it decreased progressively. Plssma lactate concentration was recovered to control level in group P at the completion of fluid challenge, but in group S, it was recovered lately. It means that tissue perfusion was more rapidly and effectively restored in group P than group S. In conclusion, infusion of pentastarch at severe hemorrhagic shock restored the hemodynamic parameter more rapidly and maintained cardiac performance more effectively during post-resuscitation period than normal saline. Infusion of pentastarch also maintained tissue perfusion more effectively but it increased intrapulmonary shunt fraction transiently.