Comparison of permissive hypotensive resuscitation, low-volume fluid resuscitation, and aggressive fluid resuscitation therapy approaches in an experimental uncontrolled hemorrhagic shock model

BACKGROUND
In this study, we aimed to compare the efficacy of aggressive fluid resuscitation, low-volume fluid resuscitation and permissive hypotensive resuscitation in an experimental uncontrolled hemorrhagic shock model.
METHODS
Forty-four male Guinea pigs were used in the study in an experimental uncontrolled shock model. Guinea pigs were split into six groups including normovolemic-normotensive fluid treatment group, normovolemic-permissive hypotensive fluid treatment group, low-volume normotensive fluid treatment group, low-volume permissive hypotensive fluid treatment group, no treatment (n=6), and sham-operated groups (n=6). Resuscitation was initiated when mean arterial pressure (MAP) reached 30 mmHg. In the permissive hypotensive resuscitation group, fluid treatment continued until MAP reached 45±5 mmHg and in the aggressive fluid groups until MAP reached 60±5 mmHg. Resuscitation fluid was hetastarch 6% (hydroxyethyl starch) in the low-volume fluid groups and Ringer’s lactate in the normovolemic fluid groups.
RESULTS
Mean survival time was 122.75±4.83 min in the normovolemic-normotensive fluid group, 130.87±16.31 min in the normovolemic-permissive hypotensive group, 122.12±11.53 min in the low-volume-normotensive fluid group, and 152.25±9.10 min in the low-volume-permissive hypotensive fluid group. Survival time was found significantly higher in the group in which low-volume-permissive hypotensive fluid treatment was applied than in the other groups.
CONCLUSION
When pressure effect was compared during treatment, permissive-hypotensive resuscitation was found more effective in both groups that received colloid and crystalloid treatment.

Deneysel kontrolsüz hemorajik þok modelinde ýlýmlý hipotansif resüsitasyonu, düþük volümlü sývý resüsitasyonu ve agresif sývý resüsitasyonu tedavi yaklaþýmlarýnýn karþýlaþtýrýlmasý

AMAÇ
Bu çalýþmada, deneysel kontrolsüz hemorajik þok modelinde agresif sývý resüsitasyonu, düþük volümlü sývý resüsitasyonu ve ýlýmlý hipotansif resüsitasyonun etkinliði karþýlaþtýrýldý.
GEREÇ VE YÖNTEM
Çalýþmada 44 erkek Guinea pig türü kobay kullanýldý. Deneysel kontrolsüz hemorajik þok modeli uygulandý. Kobaylar normovolemik-normotansif sývý tedavisi alan grup, normovolemik-ýlýmlý hipotansif sývý tedavisi alan grup, düþük volümlü-normotansif sývý tedavisi alan grup, düþük volumlü-ýlýmlý hipotansif sývý tedavisi alan grup, tedavi almayan grup (n=6) ve kontrol grubu (n=6) olmak üzere altý gruba ayrýldý. Ortalama arter basýncý (OAB) 30 mmHg olduðunda resüsitasyona baþlandý. Ilýmlý hipotansif resüsitasyon gruplarýnda OAB 45±5 mmHg olacak þekilde ve agresif resüsitasyon gruplarýnda OAB 60±5mmHg olacak þekilde sývý uygulandý. Düþük volümlü sývý tedavisi alan gruplarda hetastarch 6% (hidroksietil niþasta) ve normovolemik sývý tedavisi alan gruplarda Ringer laktat kullanýldý.
BULGULAR
Ortalama yaþam süresi normovolemik-normotansif grupta 122,75±4,83 dk, normovelemik-ýlýmlý hipotansif grupta 130,87±16,31 dk, düþük volümlü-normotansif grupta 122,12±11,53 dk, düþük volümlü-ýlýmlý hipotansif grupta 152,25±9,10 dk idi. Düþük volümlü ýlýmlý hipotansif grupta yaþam süresi diðer gruplardan istatistiksel olarak anlamlý düzeyde yüksek bulundu.
SONUÇ
Normotansif gruplarda kolloid ve kristalloid etkinliði benzer olmasýna raðmen ýlýmlý hipotansif gruplarda kolloid tedavisi daha etkili bulundu. Sývý tedavisine basýncýn etkisi karþýlaþýtýrýldýðýnda ýlýmlý hipotansif resüsitasyonun, kolloid ve kristalloid kullanýlan gruplarýn tamamýnda daha etkili olduðu bulundu.