T Tatara1, T Tsunetoh, C Tashiro. 1. Department of Anaesthesiology, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo 663-8501, Japan. ttatara@hyo-med.ac.jp
Abstract
BACKGROUND: Information is lacking concerning optimal infusion rates of crystalloid during resuscitation from acute haemorrhage. In this study, a mathematical model was used to predict infusion volume of crystalloid needed to restore and maintain blood volume after acute haemorrhage. METHODS: The scenario was a haemorrhage of 15 ml kg(-1) over 30 min in a 70 kg man. A bolus of crystalloid was administered at a rate of 40, 60, 80, 100, or 120 ml kg(-1) h(-1) until blood volume was restored. Fluid infusion rate needed to maintain blood volume for a further 1 h was computed. RESULTS: Blood volume was restored earlier at high bolus infusion rates compared with low bolus infusion rates (6 min at 120 ml kg(-1) h(-1) vs 63 min at 40 ml kg(-1) h(-1)). Fluid infusion rates for blood volume maintenance approached 33 ml kg(-1) h(-1) irrespective of bolus infusion rates. The restoration fluid volume at 40 ml kg(-1) h(-1) was 2.9 litre, three times that at 80-120 ml kg(-1) h(-1). The maintenance fluid volume at 80-120 ml kg(-1) h(-1) was 2.9 litre, 0.6 litre more than that at 40 ml kg(-1) h(-1). During the blood volume maintenance, the interstitial volume increased to 3.8 litre above normal at 40 ml kg(-1) h(-1) and to 2.5 litre at 80-120 ml kg(-1) h(-1). CONCLUSIONS: Bolus crystalloid infusion exceeding 80 ml kg(-1) h(-1) may not increase effectiveness of fluid resuscitation. Crystalloid resuscitation for more than 2 h may be detrimental in view of an excessive net fluid retention.
BACKGROUND: Information is lacking concerning optimal infusion rates of crystalloid during resuscitation from acute haemorrhage. In this study, a mathematical model was used to predict infusion volume of crystalloid needed to restore and maintain blood volume after acute haemorrhage. METHODS: The scenario was a haemorrhage of 15 ml kg(-1) over 30 min in a 70 kg man. A bolus of crystalloid was administered at a rate of 40, 60, 80, 100, or 120 ml kg(-1) h(-1) until blood volume was restored. Fluid infusion rate needed to maintain blood volume for a further 1 h was computed. RESULTS: Blood volume was restored earlier at high bolus infusion rates compared with low bolus infusion rates (6 min at 120 ml kg(-1) h(-1) vs 63 min at 40 ml kg(-1) h(-1)). Fluid infusion rates for blood volume maintenance approached 33 ml kg(-1) h(-1) irrespective of bolus infusion rates. The restoration fluid volume at 40 ml kg(-1) h(-1) was 2.9 litre, three times that at 80-120 ml kg(-1) h(-1). The maintenance fluid volume at 80-120 ml kg(-1) h(-1) was 2.9 litre, 0.6 litre more than that at 40 ml kg(-1) h(-1). During the blood volume maintenance, the interstitial volume increased to 3.8 litre above normal at 40 ml kg(-1) h(-1) and to 2.5 litre at 80-120 ml kg(-1) h(-1). CONCLUSIONS: Bolus crystalloid infusion exceeding 80 ml kg(-1) h(-1) may not increase effectiveness of fluid resuscitation. Crystalloid resuscitation for more than 2 h may be detrimental in view of an excessive net fluid retention.
Authors: Fernando G Zampieri; Flávia R Machado; Rodrigo S Biondi; Flávio G R Freitas; Viviane C Veiga; Rodrigo C Figueiredo; Wilson J Lovato; Cristina P Amêndola; Murillo S C Assunção; Ary Serpa-Neto; Jorge L R Paranhos; José Andrade; Michele M G Godoy; Edson Romano; Felipe Dal Pizzol; Emerson B Silva; Miqueias M L Silva; Miriam C V Machado; Luiz Marcelo S Malbouisson; Airton L O Manoel; Marlus M Thompson; Lanese M Figueiredo; Rafael M Soares; Tamiris A Miranda; Lucas M de Lima; Eliana V Santucci; Thiago D Corrêa; Luciano C P Azevedo; John A Kellum; Lucas P Damiani; Nilton B Silva; Alexandre B Cavalcanti Journal: JAMA Date: 2021-09-07 Impact factor: 56.272