Reposição volemica no choque por hemorragia incontrolada : estudo experimental
AUTOR(ES)
Antonio Capone Neto
DATA DE PUBLICAÇÃO
1995
RESUMO
Prehospital guidelines for the treatment of hemorrhagic shock r.ecommend rapid volume resuscitation to normal blood pressure. However, there is eviderice that fluid resuscitation (FR) to normal blood pressure in the setting of uncomtrolledl hemorrhagic shock (UHS) causes increased bleeding, hemodilution and mortality. The purpose of this study was to examine the long-term effects of different FR regimens during UHS, using a outcome rat model. UHS was produced by preliminary bleed of 3ml/100g, followed by 75% tail amputation. Experimemtal design consisted of 3 phases: 1) a "prehospital phase" with UHS arnd resuscitation aimed at mean arterial pressure (MAP) of 40mmHg (hypotensive FR) or 80mmHg (normotensive FR). It was tested FR with lactated Ringer s (LR), Hydroxyethyl-starch 6% (HES) and whole blood (WB); 2) a "hospital phase" with control of the.bleeding and continued resuscitation to MAP >80mmHg and hematocrit near 30%; 3) a three day observation phase. This study demonstrates that attempts to achieve normal MAP with LR, during uncontrolled bleeding, increases blood loss, hemodilution arid mortality. Infusion of only HES increases bleeding, hemodilution and mortality, even in hypotensive FR. The early use of blood in the treatment of UHS, avoiding severe hemodilution, may significantly improve survival in both normotensive and hypotensive resuscitation. When blood is unavailable in the prehospital setting, "hypotensive resuscitation" with LR may offer a survival benefit .
ASSUNTO(S)
ACESSO AO ARTIGO
http://libdigi.unicamp.br/document/?code=vtls000099245Documentos Relacionados
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