Pulmonary edema and rapid transfusion: the comparison between rapid intravenous and intraarterial infusion in the severely hemorrhagic anesthesized pigs.

BACKGROUND

Patients with shock often develop pulmonary edema (PE) after rapid and massive fluid supplement and intravenous infusion. Rapid intraarterial infusion (RIA) is often used for fluid supplement in cardiac surgery, but has not yet been applied to treatment of hemorrhagic shock. However, by perfusing the ischemic peripheral organs through RIA, the fluid should flow first through the venous system to the heart and lung in less volume at lower speed. Therefore, the probability of developing PE should be less than that in rapid intravenous infusion (RIV) to the heart and lung in the same condition regarding volume and speed. Accordingly, we compared RIV and RIA in the treatment of hemorrhagic shock (HS) to determine if RIA provides any beneficial effect in reducing the development of PE.

METHODS

Eleven male mini-pigs weighing 17.5-32 kg were randomly divided into two groups to have RIV and RIA. Under general anesthesia, HS was induced by shedding blood (about 35 ml/kg) through the femoral artery until the mean arterial blood pressure (MAP) fell to 50 mm Hg. This condition was maintained for three hours. Then, lactated Ringer's solution (LRS) was infused thrice by force through a femoral artery (RIA) or an external jugular vein (RIV) at a speed of 25 ml/kg/min for 3 min. Data include hemodynamics, arterial blood gases, urine output, total extravascular lung water index (ETVI), and total amount of infused LRS used to induce gross PE (endotracheal release of pinkish foamy sputum). Serum concentrations of catecholamines, platelet activating factor (PAF) and thromboxane B2 (TxB2) were measured.

RESULTS

The total amount of LRS needed to induce gross PE was significantly greater in RIA than in RIV group. ETVI after rapid transfusion with a total of 225 ml/kg LRS was significantly less in RIA than in RIV group. Also, TxB2 concentrations in serum were less in RIA group. However, there was no difference in changes of hemodynamics, blood gases, acid-base, pulmonary shunting, urine output, serum concentrations of PAF or catecholamines between these two groups.

CONCLUSIONS

RIA may be a better choice for fluid replacement in HS in terms of decreasing the development of PE and lessening the release of ETVI and TxB2 in severely hemorrhagic anesthetized pigs. Further human investigation is warranted.