Early effects of 7.5% hypertonic saline solution on splanchnic perfusion after hemorrhagic shock

• Autor(es):

  Cruz Junior, Ruy Jorge (USP. FM. INCOR);

  Yada-Langui, Margareth M. (USP. FM. INCOR);

  Garrido, Alejandra Gallardo (USP. FM. INCOR);

  Figueiredo, Luiz Francisco Poli de (UNIFESP. EPM. Depto. de Cirurgia, USP. FM. Depto. de Cardiopneumologia);

  Silva, Maurício Rocha e (USP. FM. Depto. de Cardiopneumologia).

• Fonte:

  Acta Cirurgica Brasileira; volume 21, número 2, páginas 106-112. Abril 2006.

• Assuntos:

  Shock;

  Saline Solution, Hypertonic;

  Hemorrhage;

  Splanchnic Circulation.

• Resumo:

  PURPOSE: To evaluate the effects of SSH resuscitation on systemic and splanchnic hemodynamic variables in an experimental model of controlled hemorrhagic shock. METHODS: Ten mongrel dogs were bled (20 ml/min) to a target mean arterial pressure (MAP) of 40±5 mmHg. After 30 minutes of shock, animals received SSH infused in 5-minute and they were observed for 60 minutes thereafter. Systemic hemodynamics were evaluated through a Swan-Ganz and arterial catheters while gastrointestinal tract perfusion by a catheter inside the portal vein, an ultrasonic flowprobe around portal vein blood flow (PVBF) and a gastric tonometer. Splanchnic oxygen delivery and consumption, intramucosal pH and veno-arterial, portal-arterial and mucosal-arterial pCO2-gradients (Dap-a pCO2, Dvp-a pCO2 e Dt-a pCO2, respectively) were assessed. RESULTS: Hemorrhage (29.8±2.4ml/Kg) induced significant decreases in MAP (125±6 to 42±1 mmHg), in CO (1.9±0.2 to 0.6±0.1 L/min), and PVBF (504±73 to 126±12 ml/min) while significant increases were detected in Dap-a pCO2 (5.3±0.8 to 19.9±1.6 mmHg) Dvp-a pCO2 (5.4±1.4 to 22.6±2.1 mmHg) and Dt-a pCO2 (6.1±1.1 to 43.8±7.5 mmHg). SSH infusion promoted only partial benefits in systemic and splanchnic blood flows. Reduced pCO2 gradients but fewer effects in Dt-a pCO2 were observed. CONCLUSION: The SSH infusion promoted partial systemic and splanchnic hemodynamic benefits. Those benefits were especially poor at the splanchnic microcirculation, as evaluated by Dt-a pCO2. In addition, systemic and regional oxygen-derived variables do not reflect the regional microcirculation disturbances. Gastrointestinal tonometry clearly represents a useful tool for monitoring splanchnic perfusion in patients in hemodynamic shock.

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