TY - JOUR
T1 - Early vasopressin improves short-term survival after pulmonary contusion
AU - Feinstein, Ara J.
AU - Cohn, Stephen M.
AU - King, David R.
AU - Sanui, Masamitsu
AU - Proctor, Kenneth G.
AU - Davis, Kimberly A.
AU - Raghavendran, Krishnan
AU - Dutton, Richard P.
N1 - Copyright:
Copyright 2011 Elsevier B.V., All rights reserved.
PY - 2005/10
Y1 - 2005/10
N2 - Arginine vasopressin (AVP) is a promising treatment for several types of irreversible shock, but its therapeutic potential has not been examined after severe chest trauma. Two series of experiments were performed to fill this gap Methods: Series 1: anesthetized, mechanically-ventilated pigs (n = 20, 29 ± 1 kg) received a blast to the chest, followed by a " controlled" arterial hemorrhage to a mean arterial pressure (MAP) <30 mm Hg. At 20 minutes, a 10 mL/kg normal saline (NS) bolus was followed by either 0.1 U/kg AVP bolus or NS, in randomized, blinded fashion. From 30-300 minutes, either AVP (0.4U/ kg/hr plus NS) or NS alone was infused as needed to MAP>70 mm Hg. Series 2: Swine (n = 15) received the chest injury followed by partial left hepatectomy to produce "uncontrolled" hemorrhage. Resuscitation was the same as in series 1 Results: The blast created bilateral parenchymal contusions (R > L), hemo/ pneumothorax and progressive cardiopulmonary distress. In Series 1, there were 3/20 deaths before randomization, 0/8 deaths after resuscitation with AVP versus 4/9 deaths with NS (p = 0.029). In surviving animals, with AVP versus NS, fluid requirements and peak airway pressures were lower while P/F was higher (all p < 0.05). In Series 2, with uncontrolled hemorrhage, there were 5/15 deaths before randomization. Upon resuscitation with AVP versus NS, survival time and blood loss were both improved, but the differences did not reach statistical significance Conclusions: After severe chest trauma with controlled hemorrhage, early AVP decreased mortality, reduced fluid requirements and improved pulmonary function. With uncontrolled hemorrhage, early AVP did not increase the risk for bleeding.
AB - Arginine vasopressin (AVP) is a promising treatment for several types of irreversible shock, but its therapeutic potential has not been examined after severe chest trauma. Two series of experiments were performed to fill this gap Methods: Series 1: anesthetized, mechanically-ventilated pigs (n = 20, 29 ± 1 kg) received a blast to the chest, followed by a " controlled" arterial hemorrhage to a mean arterial pressure (MAP) <30 mm Hg. At 20 minutes, a 10 mL/kg normal saline (NS) bolus was followed by either 0.1 U/kg AVP bolus or NS, in randomized, blinded fashion. From 30-300 minutes, either AVP (0.4U/ kg/hr plus NS) or NS alone was infused as needed to MAP>70 mm Hg. Series 2: Swine (n = 15) received the chest injury followed by partial left hepatectomy to produce "uncontrolled" hemorrhage. Resuscitation was the same as in series 1 Results: The blast created bilateral parenchymal contusions (R > L), hemo/ pneumothorax and progressive cardiopulmonary distress. In Series 1, there were 3/20 deaths before randomization, 0/8 deaths after resuscitation with AVP versus 4/9 deaths with NS (p = 0.029). In surviving animals, with AVP versus NS, fluid requirements and peak airway pressures were lower while P/F was higher (all p < 0.05). In Series 2, with uncontrolled hemorrhage, there were 5/15 deaths before randomization. Upon resuscitation with AVP versus NS, survival time and blood loss were both improved, but the differences did not reach statistical significance Conclusions: After severe chest trauma with controlled hemorrhage, early AVP decreased mortality, reduced fluid requirements and improved pulmonary function. With uncontrolled hemorrhage, early AVP did not increase the risk for bleeding.
KW - Hemorrhage
KW - Liver
KW - Swine
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U2 - 10.1097/01.ta.0000187654.24146.22
DO - 10.1097/01.ta.0000187654.24146.22
M3 - Article
C2 - 16374276
AN - SCOPUS:30044438407
VL - 59
SP - 876
EP - 883
JO - Journal of Trauma and Acute Care Surgery
JF - Journal of Trauma and Acute Care Surgery
SN - 2163-0755
IS - 4
ER -