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KMID : 0350519940470020873
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Journal of Catholic Medical College
1994 Volume.47 No. 2 p.873 ~ p.885
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The Effect of Pentastarch Infusion on Intrapulmonary Shunt and Cardiac Performance in Dogs Subjected to Severe Hemorrhagic Shock
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Abstract
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Volume replacement is a vital therapy in patient swith circulatory shock, but the type of fluid that should be infused remains in controversy. This study is designed to compare the cardiopulmonary effects of a colloid colution and a crystalloid
solution
in dogs subjected to severe hemorrhagic shock. Twelve dogs were bled to shock and mean arterial pressure(MAP) were maintained at 60 mmHg for 1 hour followed by 40 mmHg for additional one hour. Animals were randomized for fluid challenge with 10%
pentastarch(group P) or 0.9% normal saline(group S) to restore MAP. Hemodynamic parameters, blood gases and plasma lactate concentration were measured at pre-shock, during shock and for 2 hours after resuscitation.
Cardiac function and hemodynamic parameters were better than the control on the completion of fluid challenge with both solutions, but hemodynamic parameters got worse after resuscitation. Especially in group S, hemodynamic parameters got worse
more
significantly and rapidly than group P. Considering the relation of left ventricular stroke work index(LVSWI) and pulmonary capillary wedge pressure(PCWP), the cardiac performance was well maintained to normal level in group P during
post-resuscitation
period, but rapidly deteriorated in group S.
Intrapulmonary shunt fraction was increased and reached maximal on the completion of fluid challenge but normalized over next 1 hour. Assessment of tissue perfusion was measured by mixed venous oxygen tension(PVO2) and plasma lactate
concentration.
In
group P, PVO2 was restored to higher than the control level on the completion of fluid challenge and maintained to the control level during post-resuscitation period. In group S, PVO2 was not restored to the control level on the completion of
fluid
challenge, moreover after then, it decreased progressively. Plasma lactate concentration was recovered to the control level in group P on the completion of fluid challenge, but in group S, it was recovered late. It means that the restoration of
tissue
perfusion was more rapid and effective in group P than group S.
In conclusion, infusion of pentastarch for severe hemorrhagic shock restored the hemodynamic parameters more rapidly and maintained cardiac performance more effectively during post-resuscitation period than normal saline. Infusion of pentastarch
also
maintained tissue perfusion more effectively but it increased intrapulmonary shunt fraction transiently.
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