Podcasts about fluid resuscitation

When fluid resuscitating a hypotensive patients, how do you know when to continue with IV fluids and when to initiate vasopressors? In this episode, critical care teaching legend Nicole Kupchik, RN MSN CNS, shares evidence-based practices for determining the best course of action. Explore the significance of noninvasive measurements in assessing fluid responsiveness and learn how incorrect decisions can lead to adverse patient outcomes. Nicole Kupchik's latest book, The Critical Care Survival Guide, is a concise bedside reference book with easy-to-access resources for anyone working in critical care regardless of experience level.Studies that support the use of balanced crystalloids in fluid resuscitation versus normal saline:Balanced Crystalloids versus Normal Saline in Adults with Sepsis: A Comprehensive Systematic Review and Meta-AnalysisLactated Ringer's Solution Reduces Systemic Inflammation Compared With Saline in Patients With Acute Pancreatitis

In this episode, we discuss three fellowship vivas addressing controversies related to fluid resuscitation in septic shock, renal replacement therapy in AKI and pressure-controlled ventilation mode.

The standard of care for pancreatitis has been aggressive (liters) of intravenous fluids. New data suggests that this level of fluid resuscitation may not be needed – and possibly harmful. Join host Geoff Wall as he evaluates the role of fluids in pancreatitis treatment.The GameChangerIn patients with mild disease, moderate fluid resuscitation is safer than aggressive fluid use. Show Segments00:00 - Introduction01:17 - Current Standard of Care04:37 - The WATERFALL Study10:20 - GameChanger: Study Findings16:00 - Closing RemarksHostGeoff Wall, PharmD, BCPS, FCCP, CGPProfessor of Pharmacy Practice, Drake UniversityInternal Medicine/Critical Care, UnityPoint HealthReferences and ResourcesAggressive or Moderate Fluid Resuscitation in Acute PancreatitisRedeem your CPE or CME hereCPE (Pharmacist) CME (Physician) Get a membership & earn CE for GameChangers Podcast episodes (30 mins/episode)Pharmacists: Get a membershipPrescribers: Get a membershipCE InformationLearning ObjectivesUpon successful completion of this knowledge-based activity, participants should be able to:1. Discuss the current standard of care for treating pancreatitis2. Describe the findings of the WATERFALL study and how it applies to patients0.05 CEU/0.5 HrUAN: 0107-0000-22-440-H04-PInitial release date: 12/09/2022Expiration date: 12/09/2023Additional CPE and CME details can be found here.Follow CEimpact on Social Media:LinkedInInstagramDownload the CEimpact App for Free Continuing Education + so much more!

In this episode, we discuss a recently published randomised controlled trial evaluating the role of aggressive fluid resuscitation strategy in mild acute pancreatitis. 

Show notes at pharmacyjoe.com/episode752. In this episode, I'll discuss an article about aggressive vs moderate fluid resuscitation in acute pancreatitis. The post Episode 752: Another Strike Against Aggressive Fluid Resuscitation appeared first on Pharmacy Joe.

Show notes at pharmacyjoe.com/episode752. In this episode, I ll discuss an article about aggressive vs moderate fluid resuscitation in acute pancreatitis. The post Episode 752: Another Strike Against Aggressive Fluid Resuscitation appeared first on Pharmacy Joe.

Contributor: Aaron Lessen, MD Educational Pearls: Historically, pancreatitis has been treated with aggressive IV fluid rehydration. Recently published data shows this may not be appropriate. A randomized, controlled, multi-hospital trial evaluated outcomes for patients with acute pancreatitis receiving lactated Ringer's solution    Aggressive fluid resuscitation group received 20ml/kg bolus + 3ml/hour  Moderate fluid resuscitation groups received either 10 ml/kg bolus if hypovolemic or no bolus if normovolemic. Both moderate resuscitation groups received 1.5ml/hr.   The primary outcome was development of moderately severe or severe pancreatitis. 22.1% of aggressive fluid resuscitation and 17.3% of moderate fluid resuscitation patients developed primary outcome. The safety outcome was fluid overload. Fluid overload developed in 20.5% of aggressive resuscitation group and only 6.3% of moderate resuscitation group.   This trial was ended early due to differences in safety outcomes without obvious difference in primary outcome Overall, aggressive fluid resuscitation had no benefit in treatment of acute pancreatitis and providers should be aware of fluid overload risk.   References de-Madaria E, Buxbaum JL, Maisonneuve P, et al. Aggressive or Moderate Fluid Resuscitation in Acute Pancreatitis. N Engl J Med. 2022;387(11):989-1000. doi:10.1056/NEJMoa2202884   Summarized by Kirsten Hughes, MS4 | Edited by John Spartz, MD & Erik Verzemnieks, MD   In an effort to promote diversity, equity, and inclusion in Emergency Medicine, The Emergency Medical Minute is proud to present our 2nd annual Diversity and Inclusion Award. We support increasing the representation of underrepresented groups in medicine and extend this award to individuals applying to emergency medicine residencies during the 2022-2023 cycle. For information on award eligibility and the application process, visit https://emergencymedicalminute.com/edi-award/  

Rebroadcast of iCONNECT Healthcare Summit Webinar - original broadcast - February 2021 Dr. Ying Tung Sia, Cardiologist, Intensivist, Echocardiographer and ECMO specialist from CIUSSS-MCQ (Trois-Rivières) and Quebec Heart and Lung Institute discusses Fluid Resuscitation in Septic Shock and covers the following objectives: - Physiology of septic shock - Fluid resuscitation - Types of fluid available - Data on balanced solution Please visit https://www.ivtherapymadesimple.ca/en/content/past_events.html for previously recorded iConnect webinars. For more information, please contact iCONNECT@baxter.com

Access to video version of lecture, supplemental materials & references at: https://www.icuedu.org/fluids

Access to video version of lecture, supplemental materials & references at: https://www.icuedu.org/fluids

In this episode, Chris and Jason talk about the nuances of fluid resuscitation. Is over-resuscitation a rational fear, or with the right tools and knowledge can providers deliver the right fluid at the right time to better patient outcomes? --- Support this podcast: https://anchor.fm/guardianpodcast/support

In this episode, Dr. Mark Piehl and Dr. Peter Antevy discuss why EMS must adopt a more thoughtful approach to fluid resuscitation for critically ill or injured patients.  Specifically, patients in shock. It turns out that EMS needs to take a more of a proactive approach to recognizing the need for and administering fluids for certain patients. Dr. Piehl, and Dr. Antevy are here to put a spotlight on the value of fluid resuscitation in the pre-hospital setting, walk us through the data, and discuss the how EMS can provide the right amount of fluid in the right amount of time to make a big impact for our patients.  Dr. Peter Antevy is a Pediatric Emergency Medicine Physician, as well as an EMS Medical Director for several fire-based EMS agencies in South Florida.  Dr. Mark Piehl is a Pediatric Intensivist at WakeMed Health & Hospitals.  He is also the Assistant Medical Director for WakeMed Mobile Critical Care, and an Associate Professor of Pediatrics at the University of North Carolina School of Medicine. On top of all that Dr. Piehl is the Chief Medical Officer and Co-Founder of 410 Medical, Inc. as well as the inventor of LifeFlow. LifeFlow is a device used to deliver rapid fluid boluses or blood transfusion for patients with signs of shock.  Visit 410medical.com for more information about LifeFlow.  Click here for access studies and information that support the information expressed in this episode:  https://drive.google.com/drive/folders/152po79RnJcXI53-AlxRsoUKbH_ODnqDh?usp=sharingPlease keep emailing your questions, comments, feedback, and episode ideas to the EMS on AIR Podcast team by email at Geoff@EMSonAIR.com Visit EMSonAIR.com for the latest information, podcast episodes and other details. Follow us on Instagram @EMSOnAIR.Geoff Lassers, Paramedic I/C, AAS.  Host/Producer, EMS on AIR PodcastFirefighter/Paramedic, West Bloomfield Fire DepartmentEMS System Manager, Oakland County Medical Control AuthorityDirector of Sponsorships, GuardianCME.comGeoff@EMSonAIR.com      Support the show

In this VETgirl online veterinary continuing education podcast, we interview Dr. Deborah Silverstein, DACVECC, Professor of Critical Care and Dr. Nolan Chalifoux, ECC resident, at University of Pennsylvania PennVet on their recent study "Effectiveness of intravenous fluid resuscitation in hypotensive cats: 82 cases (2012-2019)." Tune in to find out if cats respond to IV fluid resuscitation when hypothermic, hypotensive, and critically ill, and learn more about all things fluid therapy in cats!

Contributor: Chris Holmes, MD Educational Pearls: Parkland Formula: 4 mL x [Total Body Surface Area Burned (%)] x [body weight (kg)] given in 24 hours 50% given over 8 hours and 50% given over the next 16 hours Brooke Formula: 2 mL x [Total Body Surface Area Burned (%)] x [body weight (kg)] given in 24 hours 50% given over 8 hours and 50% given over the next 16 hours 2009 military study evaluated Parkland vs. Brooke formulas for severe burn patients and found the outcomes were the same Guidelines are in flux on which formula to use, but reducing the overall volume using the Brooke formula can be done without significant change in morbidity or mortality Using fluid responsiveness by measuring urine output and signs of fluid overload can help guide overall resuscitative approach in burn patients References Chung KK, Wolf SE, Cancio LC, et al. Resuscitation of severely burned military casualties: fluid begets more fluid. J Trauma. 2009;67(2):231-237. doi:10.1097/TA.0b013e3181ac68cf Schaefer TJ, Nunez Lopez O. Burn Resuscitation And Management. [Updated 2021 Aug 11]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK430795/ Summarized by John Spartz, MS4 | Edited by Erik Verzemnieks, MD ********************* The Emergency Medical Minute is excited to announce that we are now offering AMA PRA Category 1 credits™ via online course modules. To access these and for more information, visit our website at https://emergencymedicalminute.org/cme-courses/ and create an account.  Donate to EMM today! Diversity and Inclusion Award

2021 MMPDr. Galvagno's slides

Malnutrition is a major global health problem. Childhood malnutrition increases the risk of morbidity & mortality and has been shown to underlie almost half of the total number of deaths in children less than 5-years. In this lecture, we will review cardiac function and fluid resuscitation in critical illness states among severely malnourished children.

Welcome back to the Brown Surgery Podcast. Today we going to continue our quick-shot podcast series on the basics of fluid resuscitation. This is a concept that is often discussed and which clinicians encounter frequently, especially junior residents and advanced practice providers who find themselves covering critical care units managing patients with shock. Joining me today to discuss this topic is Dr. Michael Connolly, MD. Mike is an associate professor of surgery and one of our trauma, critical care surgeons here at Brown Surgery. Please comment if you enjoy these quick shot podcasts. If there is a topic you would like us to cover, please email me at: Kenneth_Lynch@brown.edu

Over the last two decades, there have been several landmark fluid resuscitation trials published. These trials have provided evidence that the type of intravenous fluids we choose for resuscitation can impact important patient-centred outcomes.  This presentation will look at what we know from these trials focused on fluid resuscitation in sepsis and septic shock; specifically, an overview of the principles of fluid resuscitation, types of fluids, review the fluid resuscitation evidence and describe changes in fluid resuscitation practices over time.

Burns Fluid Resuscitation. The first 24 hours for burns management is crucial.  The ability to deliver just the right amount of fluid in a patient with burns is the holy grail. From #CodaZero Claire Seiffert presents on Burns Fluid Resuscitation. Claire covers fluid overloaded with compartment syndrome, to underdone with an AKI and extension of burns. This short update will provide an overview of how to achieve the “just right” fluid balance and targets for resuscitation, ultimately enhancing patient outcomes. For more head to: codachange.org/podcasts 

Eoghan and Alasdair discuss the current dilemmas in fluid resuscitation in septic patients. Despite many research studies over the past 15 years, many questions still exist: what are the ideal endpoints for volume resuscitation?; what are the best fluids to give?; and when and how to start vasopressors?. Alasdair covers what we know and what we don't, and how we might get the right answers.

I interview Wesley Trauma Services Trauma Surgeon and Burn Surgeon Dr. William Waswick about burn assessment, fluid resuscitation, and associated injuries of burns.  

In this short and sweet episode, we tackle the different types of IV fluids, what they are, their composition and when you should administer them. LINKS! Youtube video: https://youtu.be/OWMJ_gjnCAk and lecture notes found at: https://bit.ly/utdnotesIVFluids

Show notes at pharmacyjoe.com/episode482. In this episode, I ll discuss an article about starting norepinephrine before fluid resuscitation is complete in septic shock. The post 482: Should norepinephrine be started before fluid resuscitation is complete? appeared first on Pharmacy Joe.

Today we are joined by the man, the myth, and the legend, Dr. Stacy Johnson, to talk about a new meta-analysis of using aspirin for DVT prophylaxis after a total hip or knee replacement. We also review a new retrospective cohort study from Cleveland Clinic on whether it's safe to give the recommended 30 ml/kg fluid bolus to patients with sepsis who also have CHF, cirrhosis or ESRD. Check it out! Aspirin for VTE Prophylaxis after THA or TKA Fluid Management for Sepsis in Patients with ESRD, Cirrhosis and CHF Music from https://filmmusic.io"Sneaky Snitch" by Kevin MacLeod (https://incompetech.com)License: CC BY (http://creativecommons.org/licenses/by/4.0/)

Rizwan A. Khan, MD, and Anita J. Reddy, MD, join CHEST Podcast Editor, Gretchen R. Winter, MD, to discuss the association between volume of fluid resuscitation and intubation in high risk septic patients with heart failure, end stage renal disease, and cirrhosis.

This episode will get you thinking about intravenous fluid choices for when you are next managing a hypovolaemic trauma patient. Dr. John Dyett, an Intensive Care Specialist at Eastern Health & Retrieval Consultant at Adult Retrieval Victoria discusses the key principles of fluid resuscitation in the severely hypovolemic Major Trauma patient. John explains the aims for haemostatic resuscitation, rationales for blood product administration and how to prevent or modify the effects of the lethal triad.

Fluid resuscitation

Chris Montera of EMS Garage interviews Dr. Mark Piehl and Paramedic Tim Jaffry about prehospital fluid resuscitation in patients with hypotension or shock.  Follow EMS World on Twitter, Facebook, LinkedIn, and Instagram. EMS World Expo will be held Sept. 14–18, 2020 in Las Vegas!

Dr Valerie Marshall talking about Fluid Resuscitation. This was recorded at the Paediatric Emergencies - Waiting for the Retrieval Team event in Belfast in 2019.

This week on the podcast we're reviewing a lesson from the Burn Section of the EPICC Review Course concerning fluid resuscitation.  Listen in as I discuss the most current recommendations from the American Burn Association on the Prehospital and Early Hospital management of IV fluids in the burn patient.  I also give you 1 easy tip to simplify the ABA's recommendation even further, as well as review what you need to know about determining Total Body Surface Area burned and Fluid Resuscitation for the FP-C, CCP-C, and CFRN exam.

Episode one of our foundations series is a brief primer on performing fluid resuscitation in patients with hypovolaemic shock.  If you have any questions, please head to our Facebook page (www.facebook.com/vetemergecc) or our website (www.vetemerge.cc). Belows is a link for calculating fluid rates following resuscitation: https://www.aaha.org/public_documents/professional/guidelines/fluidtherapy_guidlines_toolkit.pdf Further reading about hypovolaemic shock and fluid therapy: http://www.vetfolio.com/cardiology/shock-pathophysiology

Base deficit and excess are reliable biomarkers in determining the severity of our patients’ conditions. But is a deficit an automatic indicator for fluid resuscitation, as some may believe? Tune in as we discuss acid/base balance and what you should base fluid resuscitation on. We also include an updated mnemonic that will help you remember the causes of metabolic acidosis. ------------------------------------------------ Follow us on Twitter @HLTHPodcast Follow us on Facebook @heavyliesthehelmet Visit our website at heavyliesthehelmet.com Contact us at heavyliesthehelmet@gmail.com Disclaimer: The views, information, or opinions expressed during the HLTH podcast are solely those of the individuals involved and do not necessarily represent those of their employers and their employees. HLTH is not responsible for the accuracy of any information contained in the podcast series available for listening or reading on this site. The primary purpose of this podcast series is to educate and inform. This podcast series does not constitute other professional advice or services.

When should we give fluids in sepsis?  How much? This is a question that has troubled emergency physicians, intensivists and anaesthetists for decades.  Given how common the condition is, it is surprising that there is such a paucity of quality evidence to guide practice. Dr Stephen McDonald is an emergency physician from Perth, Australia, and is heading up the ARISE-Fluids trial that will explore the question of whether earlier vasoconstrictor support and restriction of fluids in the early resuscitation period improves outcomes. This interview was recorded at the 20th annual meeting of the ANZICS Clinical Trials Group in Noosa, Queensland

Ludwig Lin, MD, speaks with Daniel E. Leisman, BS, about the article, Patterns and Outcomes Associated With Timeliness of Initial Crystalloid Resuscitation in a Prospective Sepsis and Septic Shock Cohort, published in Critical Care Medicine.

Ludwig Lin, MD, speaks with Daniel E. Leisman, BS, about the article, Patterns and Outcomes Associated With Timeliness of Initial Crystalloid Resuscitation in a Prospective Sepsis and Septic Shock Cohort, published in Critical Care Medicine.

How to diagnose dehydration and decide the best way to get your patient the fluids they need

Gregory A. Schmidt, MD, FCCP, and Pierre Kory, MD, join CHEST podcast editor, D. Kyle Hogarth, MD, FCCP, to discuss their Point/Counterpoint debate on the value of inferior vena cava ultrasound to determine the use of acute fluid resuscitation for patients in shock.

This week we do a little spaced repetition on adrenal insufficiency and then discuss fluid responsiveness and resuscitation. https://media.blubrry.com/coreem/content.blubrry.com/coreem/Podcast_Episode_75_0_Final_Cut.m4a Download Leave a Comment Tags: Adrenal Insufficiency, Critical Care, Fluid Responsiveness, Fluid Resuscitation, Sepsis, Septic Shock Show Notes Read More Marik PE. Fluid responsiveness and the six guiding principles of fluid resuscitation. Crit Care Med 2016. PMID: 26571187 LITFL: Adrenal Insufficiency EMCrit: Podcast 64 – Assessing Fluid Responsiveness with Dr. Paul Marik Core EM: Adrenal Crisis Core EM: Episode 15.0 – Adrenal Crisis

This week we do a little spaced repetition on adrenal insufficiency and then discuss fluid responsiveness and resuscitation. https://media.blubrry.com/coreem/content.blubrry.com/coreem/Podcast_Episode_75_0_Final_Cut.m4a Download Leave a Comment Tags: Adrenal Insufficiency, Critical Care, Fluid Responsiveness, Fluid Resuscitation, Sepsis, Septic Shock Show Notes Read More Marik PE. Fluid responsiveness and the six guiding principles of fluid resuscitation. Crit Care Med 2016. PMID: 26571187 LITFL: Adrenal Insufficiency EMCrit: Podcast 64 – Assessing Fluid Responsiveness with Dr. Paul Marik Core EM: Adrenal Crisis Core EM: Episode 15.0 – Adrenal Crisis References

Editor's Audio Summary by Mary McGrae McDermott, MD, Senior Editor of JAMA, the Journal of the American Medical Association, for the September 27, 2016 issue

When managing septic shock, passive leg raising is the best test to determine if a patient is likely to respond to a fluid bolus, better than CVP lines or even bedside ultrasound. Dr Najib Ayas, Associate professor of Critical Care Medicine at the University of British Columbia, discusses shock management from the context of his Rational Clinical examination article in the September 27, 2016 issue of JAMA, entitled “Will This Hemodynamically Unstable Patient Respond to a Bolus of Intravenous Fluids?”

When managing septic shock, passive leg raising is the best test to determine if a patient is likely to respond to a fluid bolus, better than CVP lines or even bedside ultrasound. Dr Najib Ayas, Associate professor of Critical Care Medicine at the University of British Columbia, discusses shock management from the context of his Rational Clinical examination article in the September 27, 2016 issue of JAMA, entitled “Will This Hemodynamically Unstable Patient Respond to a Bolus of Intravenous Fluids?”  

Learn about the initial management of burns by reviewing burn formulas, small and large burn resuscitations, and maintaining fluid. Initial publication: August 28, 2013. Last reviewed: May 15, 2019. Please visit: www.openpediatrics.org OPENPediatrics™ is an interactive digital learning platform for healthcare clinicians sponsored by Boston Children's Hospital and in collaboration with the World Federation of Pediatric Intensive and Critical Care Societies. It is designed to promote the exchange of knowledge between healthcare providers around the world caring for critically ill children in all resource settings. The content includes internationally recognized experts teaching the full range of topics on the care of critically ill children. All content is peer-reviewed and open access-and thus at no expense to the user. For further information on how to enroll, please email: openpediatrics@childrens.harvard.edu

David Farcy, MD FAAEM FCCM, Chairman, Department of Emergency Medicine at Mount Sinai Medical in Miami Beach, Florida, speaks with Peter DeBlieux, MD FAAEM, Professor of Medicine at Louisiana State University Health & Science Center in New Orleans. In this episode, Drs. Farcy and DeBlieux discuss the fluids used in fluid resuscitation including isotonic crystalloids and albumin. Intro music by SaReGaMa, "Sky is the Limit," from the album "Sky is the Limit," powered by JAMENDO.

Read the article: http://www.bmj.com/content/348/bmj.f7003 The 2013 World Health Organization guidelines continue to recommend rapid fluid resuscitation for children with shock, despite evidence from the FEAST trial that this can increase mortality. Katheryn Maitland, professor of tropical paediatric infectious disease at Imperial College London, who led the FEAST trial, joins us to discuss it.

The erudite John Myburgh condenses fluid resuscitation data down to a palatable brew. 

Chad Meyers' lecture on fluid resus in severe sepsis

Eric Bauer discusses hypovolemic shock, permissive hypotension techniques and theory, and how fluid affect oxygenation.

Eric Bauer discusses hypovolemic shock, permissive hypotension techniques and theory, and how fluid affect oxygenation.See omnystudio.com/listener for privacy information.

PONV and Fluid Resuscitation

Dr. Timothy B. Gardner discusses his manuscript "Early Fluid Resuscitation Reduces Morbidity Among Patients With Acute Pancreatitis." To view the print version of this abstract go to http://tiny.cc/rye14

Early Fluid Resuscitation Reduces Morbidity Among Patients With Acute Pancreatitis; Lactated Ringer's Solution Reduces Systemic Inflammation Compared With Saline in Patients With Acute Pancreatitis. Dr. Kuemmerle interviews author Dr. Timothy B. Gardner

Host, Dr. Jeffrey Guy, Trauma Surgeon and Director at the Vanderbilt Regional Burn Center talks about changes in fluid & blood resuscitation in the critically ill patient with Dr. Bryan Cotton, specialist in emergency general surgery, trauma surgery and surgical critical care. What are we doing right and what can we do better? And hear about strategy of damage control resuscitation and 1-to-1-to-1 transfusion practices in military combat used now in civilian care.

Fluid resuscitation done poorly can result in significant complications to the patient.  This episode will present some of the newer considerations in fluid resuscitation in traumatic shock. 

Vasopressor Agents or Fluid Resuscitation for the Treatment of Uncontrolled Hemorrhagic Shock, an Experimental Approach in a Porcine Liver Trauma Model The standard approach to the traumatized victim in uncontrolled hemorrhagic shock is to infuse large amounts of crystalloid and colloid fluids as early, and as rapidly as possible. The aim of this strategy is to restore intravascular volume immediately and to maintain vital organ perfusion. The results of many laboratory studies and one clinical trial question the effectiveness of this treatment recommendation and suggest that in the case of uncontrolled hemorrhage aggressive fluid resuscitation may even be harmful. Hence, we evaluated the effects of fluid resuscitation vs. epinephrine vs. vasopressin vs. saline placebo on hemodynamic variables, regional organ blood flow, and short term survival in an animal model of uncontrolled hemorrhagic shock. Twenty-eight anesthetized pigs were subjected to a severe liver injury, which resulted in an average blood loss of 35 mL/kg within 30 minutes. When mean arterial pressure was < 20 mmHg, and heart rate declined progressively, the pigs were randomly assigned to receive either 1000 mL lactated Ringer´s solution and 1000 mL of gelatine solution (n=7), or an intravenous bolus dose and continuous infusion of 45 µg/kg epinephrine (n=7), or 0.4 IU/kg Vasopressin (n=7), or saline placebo (n=7). At 30 minutes after therapeutic intervention all surviving animals have been fluid resuscitated and further blood loss has been controlled surgically. Mean ± SEM arterial blood pressure at 5 minutes after therapeutic intervention was significantly (p< 0.0001 for vasopressin vs. epinephrine vs. placebo and p< 0.04 for vasopressin vs. fluid resuscitation) higher after vasopressin vs. fluid resuscitation vs. epinephrine vs. saline placebo (58 ± 9 vs. 32 ± 6 vs. 19 ± 5 vs. 7 ± 3 mmHg; respectively). Although vasopressin improved regional organ blood flow, this effect did not result in further blood loss stemming from the liver injury (vasopressin vs. fluid resuscitation vs. epinephrine vs. saline placebo 10 minutes after intervention, 1343 ± 60 vs. 2536 ± 93 vs. 1383 ± 117 vs. 1326 ± 46 mL; respectively; p

In severe hemorrhagic shock, left ventricular (LV) diastolic dysfunction is an early sign of cardiac failure due to compromised myocardial oxygenation. Immediate fluid replacement or, in particular, administration of a hemoglobin-based oxygen carrier (diaspirin cross-linked hemoglobin; DCLHb) improves myocardial oxygenation; therefore, positive effects on LV diastolic function could be expected. The effects of fluid resuscitation from severe hemorrhagic shock with DCLHb were investigated in 20 anesthetized domestic pigs. After generation of a critical left anterior descending coronary artery stenosis (narrowing of the artery until disappearance of reactive hyperemia after a 10-second complete vessel occlusion), hemorrhagic shock (mean arterial blood pressure 45 mm Hg) was induced within 15 min by controlled blood withdrawal and maintained for 60 min. Fluid resuscitation consisted of replacement of the plasma volume withdrawn during hemorrhage by infusion of either 10% DCLHb (DCLHb group, n = 10) or 8% human serum albumin (HSA) oncotically matched to DCLHb (HSA group, n = 10). After completion of resuscitation, an observation period of 60 min elapsed. Measurements of central hemodynamics, myocardial oxygenation, and LV Stolic function were performed at baseline, after induction of critical coronary artery stenosis, after 60 min hemorrhagic shock, immediately after resuscitation, and 60 min later. While 5 out of 10 animals treated with died within the first 20 min after fluid resuscitation from acute LV pump failure, all DCLHb-treated animals survived until the end of the protocol (p < 0.05). Despite superior myocardial oxygenation due to augmentation of the arterial O-2 content as well as of coronary perfusion pressure, no beneficial effects on LV diastolic function were observed after infusion of DCLHb. Peak velocity Of LV pressure decrease (dp/dt(min)) did not reveal significant differences between the two groups. Immediately after completion of fluid resuscitation with DCLHb, the time constant of LV diastolic relaxation (tau) was prolonged when compared with HSA-treated animals (p < 0.05), indicating retardation of early LV diastolic relaxation. Our data suggest that DCLHb fails to improve LV diastolic function after fluid resuscitation from severe hemorrhagic shock. However, positive effects on myocardial perfusion. and oxygenation result in a significant reduction of the mortality of severe hemorrhagic shock. Copyright (C) 2001 S.Karger AG, Basel.