Ulus Travma Acil Cerrahi Derg. 2017; 23(4): 287-293 | DOI: 10.5505/tjtes.2016.50487

Comparison of warm fluid and cold fluid resuscitation during uncontrolled hemorrhagic shock model in rats

Serkan Dilmen¹, Mehmet Eryýlmaz², Salih Müjdat Balkan³, Muhittin Serdar⁴, Murat Durusu², Ali Osman Yýldýrým⁵, Sanem Aslýhan Dilmen^6
1Department of Cardiovascular Surgery, GATA Medical Faculty, Ankara, Turkey
²Department of Emergency Medicine,GATA Medical Faculty, Ankara, Turkey
³Department of General Surgery, TOBB ETU Hospital, Ankara, Turkey
⁴Department of Biochemistry, Acýbadem University, Ankara, Turkey
⁵Department of Emergency Medicine, GATA Haydarpasa Military Hospital, Istanbul, Turkey
⁶Department of Physical Medicine and Rehabilitation, Ankara Physical Medicine and Rehabilitation Training and Research Hospital, Ankara-Turkey

BACKGROUND: This study was designed to compare the effects of resuscitation with cold and warm fluid on survival time, rate and volume of hemorrhage, hemodynamics, hypothermia, coagulopathy, acid-base balance, hematocrit, lactate, and base deficit during uncontrolled hemorrhagic shock (HS) model in rats.
METHODS: HS model was created with splenic vascular and parenchymal injury in 29 rats under ketamine and xylazine anesthesia. Thirty minutes after the hemorrhage, the rats were randomized to receive 14.5 mL/kg 0.9% sodium chloride solution at either 24ºC (Group 1; n=9) or 4ºC (Group 2; n=10) for 20 minutes. Groups 1 and 2 were compared with group that did not receive fluid (Group 3; n=10). Statistical data were represented as mean±SD. SPSS for Windows, Version 15.0 (SPSS, Inc., Chicago, IL, USA) software, Bonferroni-adjusted Mann-Whitney U test and Kaplan-Meier procedure were used to perform statistical data analysis. P value of ≤0.05 was considered statistically significant.
RESULTS: Cold fluid resuscitation decreased survival time due to increased rate and volume of hemorrhage, acidosis, hypothermia, lactate, and base deficit and decreased blood pressure and hematocrit.
CONCLUSION: There is a great need for further experimental and clinical trials on fluid resuscitation in trauma in order to define which fluid should be administered, temperature of the fluid, quantity to be delivered, and duration.

Keywords: Fluid resuscitation, hemorrhagic shock, intravenous cold fluid, rat.

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Sýçanlarda oluþturulan kontrolsüz hemorajik þok modelinde ýlýk sývý ile soðuk sývý resüsitasyonlarýnýn karþýlaþtýrýlmasý

Serkan Dilmen¹, Mehmet Eryýlmaz², Salih Müjdat Balkan³, Muhittin Serdar⁴, Murat Durusu², Ali Osman Yýldýrým⁵, Sanem Aslýhan Dilmen^6
1GATA Týp Fakültesi, Kalp ve Damar Cerrahi Ana Bilim Dalý, Ankara
²GATA Týp Fakültesi, Acil Týp Ana Bilim Dalý, Ankara
³Özel TOBB ETÜ Hastanesi, Genel Cerrahi Bölümü, Ankara
⁴Acýbadem Üniversitesi, Biyokimya Ana Bilim Dalý, Ankara
⁵GATA Haydarpaþa Asker Hastanesi, Acil Týp Ana Bilim Dalý, Ýstanbul
⁶Ankara Fizik Tedavi ve Rehabilitasyon Eðitim ve Araþtýrma Hastanesi, Ankara

AMAÇ: Bu çalýþma, sýçanlarda oluþturulan kontrolsüz hemorajik þok (HÞ) modelinde, soðuk sývý resüsitasyonunun yaþam süresi, kanama miktarý, kanama hýzý, hemodinami, hipotermi, koagülopati, asit-baz dengesi, hematokrit, laktat ve baz defisit üzerine etkilerini, ýlýk sývý resüsitasyonunun etkileriyle karþýlaþtýrmak için planlandý.
GEREÇ VE YÖNTEM: Çalýþmada ketamin ve ksilazinle anestezi altýna alýnan 29 sýçanýn dalaðýnda, vasküler ve parankim yaralanmasý ile HÞ modeli oluþturuldu. Hemorajik þokun 30. dakikasýnda, sýçanlara randomize olarak, 14.5 ml/kg dozunda %0.9 NaCl solüsyonu, 24 ºC sýcaklýkta (Grup 1, n=9) ve 4 ºC sýcaklýkta (Grup 2, n=10) 20 dakika süreyle intravenöz infüze edildi. Grup 1 ve 2’nin tedavi etkinliði, sývý tedavisi uygulanmayan grupla (Grup 3, n=10) karþýlaþtýrýldý. Ýstatistiksel olarak veriler, ortalama±standart sapma olarak hesaplandý. Ýstatistiksel analiz için SPSS for Windows 15.0 programý, Bonferroni düzeltmeli Mann-Whitney U-testi ve Kaplan-Meier prosedürü kullanýldý. P≤0.05 olduðunda, istatistiksel olarak anlamlý kabul edildi.
BULGULAR: Soðuk sývý resüsitasyonu kanama miktarýný, kanama hýzýný, asidozu, hipotermiyi, laktatý, baz defisitini artýrarak ve de kan basýncýný, hematokriti düþürerek yaþam süresini kýsaltmýþtýr.
TARTIÞMA: Travmada sývý resüsitasyonu ile ilgili olarak; hangi sývýnýn, hangi sýcaklýkta, hangi miktarda ve ne kadar sürede verileceðini inceleyen birçok deneysel ve klinik çalýþmalarýn planlanmasýna büyük ihtiyaç olduðu deðerlendirilmiþtir.

Anahtar Kelimeler: Hemorajik þok, intravenöz soðuk sývý, sýçan, sývý resüsitasyonu.

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