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Volume Kinetics of Intravenous Fluid Therapy in the Prehospital Setting

Published online by Cambridge University Press:  28 June 2012

Christer Svensén ,
Fredrik Sjöstrand  and
Robert G. Hahn
Christer Svensén
Affiliation:
Department of Anesthesiology, Söder Hospital, Stockholm, Sweden
Fredrik Sjöstrand
Affiliation:
Department of Anesthesiology, Söder Hospital, Stockholm, Sweden
Robert G. Hahn*
Affiliation:
Department of Anesthesiology, Söder Hospital, Stockholm, Sweden
*
Department of Anesthesiology, Söder Hospital, S-118 83 Stockholm, Sweden, E-mail: [email protected]
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Abstract

Introduction:

To study the volume effect of isotonic and hypertonic crystalloid fluid during ambulance transports after mild trauma, a prospective case-control study was initiated, using the ambulance and helicopter transport system in Stockholm.

Methods:

The hemodilution resulting from intravenous infusion of 1.0 L of Ringer's acetate solution (n = 7) or 250 ml of 7.5% sodium chloride (n = 3) over 30 minutes (min) was measured every 10 min during 1 hour when fluid therapy was instituted at the scene of an accident, or on arrival at the hospital. The dilution was studied by volume kinetic analysis and compared to that of matched, healthy controls who received the same fluid in hospital.

Result:

The hemodilution at the end of the infusions averaged 7.7% in the trauma patients and 9.1% in the controls, but the dilution was better maintained after trauma. The kinetic analysis showed that the size of the body fluid space expanded by Ringer's solution was 4.6 L and 3.8 L for the trauma and the control patients, respectively, while hypertonic saline expanded a slightly larger space. For both fluids, trauma reduced the elimination rate constant by approximately 30%.

Conclusion:

Mild trauma prolonged the intravascular persistence of isotonic and hypertonic crystalloid fluid as compared to a control group.

Resumen

Objetivo:

Estudiar el efecto sobre la volemia de fluidos cristaloides isotónicos e hipertónicos durante el transporte en ambulancia de traumas leves.

Diseño:

Estudio prospectivo, de casos de controles.

Ambiente:

Sistema de transporte por ambulancia y helicoptero en Estocolmo.

Materiales y métodos:

la hemodilución resultante de la infusión endovenosa de 1 litro de solución de acetato de RINGER (n=7) o 250 ml de cloruro de sodio al 7.5% (n=3) en 30 minutos fue medida cada 10 minutos durante una hora cuando se instituyó la terapia con fluido en el sitio de un accidente o a la llegada al hospital. La dilución fue estudiada por análisis cinético de volumen y comparado con el de controles sanos que recibieron el mismo fluido en el hospital.

Resultados:

La hemodilusión al final de las infusiones promedió 7.7% en los pacientes con trauma y 9.1% en los controles, pero la dilución se mantuvo mejor después del trauma. En análisis cinético mostró que el tamaño del espacio de líquido corporal expandido por la solución de RINGER fue de 4.6 litros y 3.8 litros para los pacientes con trauma y los controles respectivamente, en tanto que la solución salina hipertónica expandió un espacio ligeramente mayor. Para ambos fluidos el trauma redujo la velocidad de eliminación aproximadamente 30%.

Conclusión:

El trauma leve prolongó la persistencia intravascular de los fluidos cristaloides isotónicos e hipertónicos en comparación con un grupo control.

Keywords

hemorrhagic shockhypovolemiaintravenous fluidspharmacokineticsresuscitation
Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 16 , Issue 1 , March 2001 , pp. 9 - 13
Copyright
Copyright © World Association for Disaster and Emergency Medicine 2001

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References

1.Kaweski, SM, Sise, MJ, Virgilio, RW: The effect of prehospital fluids on survival in trauma patients. J Trauma 1990:30:1215–1219.CrossRefGoogle ScholarPubMed
2.Pollack, CV: Prehospital fluid resuscitation of the trauma patient. An update on the controversies. Emerg Med Clin N Am 1993:11:61–70.CrossRefGoogle ScholarPubMed
3.Maningas, PA, Mattox, KL, Pepe, PE, Jones, RL, Feliciano, DV, Burch, JM: Hypertonic saline-dextran solutions for the prehospital management of traumatic hypotension. Am J Surg 1989:157:528–533.CrossRefGoogle ScholarPubMed
4.Wade, CE, Kramer, GC, Grady, JJ, Fabian, TC, Younes, RN: Efficacy of hypertonic 7.5% saline and 6% dextran-70 in treating trauma: A meta-analysis of controlled clinical studies. Surgery 1997:122:609–616.CrossRefGoogle ScholarPubMed
5.Kramer, GC, Perron, PR, Lindsey, C, Ho, HS, Gunther, RA, Boyle, WA, Holcroft, JW: Small-volume resuscitation with hypertonic saline dextran solution. Surgery 1986:100:239–247.Google ScholarPubMed
6.Svensén, C, Hahn, RG: Volume kinetics of Ringer solution, dextran 70 and hypertonic saline in male volunteers. Anesthesiology 1997:87:204–212.CrossRefGoogle ScholarPubMed
7.Drobin, D, Hahn, RG: Volume kinetics of Ringer's solution in hypovolemic volunteers. Anesthesiology 1999:90:81–91.CrossRefGoogle ScholarPubMed
8.Svensén, C, Ponzer, S, Hahn, RG. Volume kinetics of Ringer solution after surgery for hip fracture. Can J Anaesth 1999:46:133–141.CrossRefGoogle ScholarPubMed
9.Hahn, RG, Svensén, C: Plasma dilution and the rate of infusion of Ringer's solution. Br J Anaesth 1997:79:64–67.CrossRefGoogle ScholarPubMed