Adenocaine and Mg2+ reduce fluid requirement to maintain hypotensive resuscitation and improve cardiac and renal function in a porcine model of severe hemorrhagic shock

作者：Granfeldt Asger^*; Nielsen Torben K; Solling Christoffer; Hyldebrandt Janus A; Frokiaer Jorgen; Wogensen Lise; Dobson Geoffrey P; Vinten Johansen Jakob; Tonnesen Else

来源：Critical Care Medicine, 2012, 40(11): 3013-3025.

DOI：10.1097/CCM.0b013e31825fd4ed

• adenocaine
• adenosine
• cardiac
• hemorrhagic shock
• kidney failure
• lidocaine
• porcine
• resuscitation

Objectives: Hypotensive resuscitation is gaining clinical acceptance in the treatment of hemorrhagic shock. Our aims were to investigate: 1) the effect of 7.5% NaCl with adenocaine (adenosine and lidocaine, AL) and AL with Mg2+ (ALM) on fluid requirement to maintain a minimum mean arterial pressure of 50 mm Hg, and 2) the effect of a second bolus of 0.9% NaCl with AL during return of shed blood on cardiac and renal function in a porcine model of hemorrhagic shock. %26lt;br%26gt;Design: Pigs were randomized to: Sham (n = 5), Sham + ALM/AL (n = 5), hemorrhage control (n = 11), or hemorrhage + ALM/AL (n = 9). Hemorrhage animals were bled to a mean arterial pressure of 35 mm Hg. After 90 mins, pigs were fluid resuscitated with Ringers acetate and 20 mL 7.5% NaCl with ALM to maintain a target mean arterial pressure of minimum 50 mm Hg. Shed blood and 0.9% NaCl with AL were infused 30 mins later. Hemorrhage control group was subjected to the same protocol but without ALM/AL. Hemodynamics, cardiodynamics (pressure-volume analysis), oxygen consumption, and kidney function were measured for 6 hrs. %26lt;br%26gt;Setting: University hospital laboratory. %26lt;br%26gt;Subjects: Female farm-bred pigs. %26lt;br%26gt;Results: Fluid volume infused during hypotensive resuscitation was 40% less in the 7.5% NaCl-/ALM-treated pigs than controls (25 vs. 41 mL/kg, p%26lt;.05). ALM was associated with a significant increase in dp/dt(max), end-systolic blood pressure, and systemic vascular resistance. Return of shed blood and 0.9% NaCl/AL reduced whole body oxygen consumption by 27% (p %26lt; .05), and significantly improved the end-systolic pressure-volume relationship and preload recruitable stroke work compared to controls. Glomerular filtration rate in the ALM/AL group returned to 83% of baseline compared to 54% in controls (p = .01). %26lt;br%26gt;Conclusion: Resuscitation with 7.5% NaCl ALM increases cardiac function and reduces fluid requirements during hypotensive resuscitation, whereas a second AL infusion during blood resuscitation transiently reduces whole body oxygen consumption and improves cardiac and renal function. (Crit Care Med 2012; 40: 3013-3025)

• 出版日期2012-11