Open AccessMean arterial pressure targeted fluid resuscitation may lead to fluid overload: A bleeding-resuscitation animal experiment
Author(s) -
Nándor Öveges,
István László,
Krisztián Tánczos,
Márton Németh,
Gábor Lebák,
Bianca-Andreea Tudor-Drobjewski,
Dániel Érces,
József Kaszaki,
László Rudas,
Wolfgang Huber,
Zsolt Molnár
Publication year - 2018
Publication title -
plos one
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.99
H-Index - 332
ISSN - 1932-6203
DOI - 10.1371/journal.pone.0196188
Subject(s) - resuscitation , medicine , mean arterial pressure , stroke volume , anesthesia , hemodynamics , pulse pressure , cardiac index , blood pressure , central venous pressure , shock (circulatory) , cardiac output , heart rate , cardiology
Fluid resuscitation is the cornerstone of treatment in hemorrhagic shock. Despite increasing doubts, several guidelines recommend to maintain mean arterial pressure (MAP) >65 mmHg as the most frequent indication of fluid therapy. Our aim was to investigate the effects of a MAP-guided management in a bleeding-resuscitation animal experiment. Materials and methods After anesthesia and instrumentation (t bsl ) animals were bled till the initial stroke volume index dropped by 50% (t 0 ). Fluid replacement was performed in 4 equivalent steps (t 1-4 ) with balanced crystalloid solution to reach the baseline values of MAP. Invasive hemodynamic measurements and blood gas analyses were performed after each step. Results Mean arterial pressure dropped from t bsl to t 0 (114±11 vs 76.9±16.9 mmHg, p <0.001) and returned to baseline by t 4 (101.4±14.4 mmHg). From t bsl -t 0 stroke volume index (SVI), cardiac index (CI) decreased (SVI: 40±8.6 vs 19.3±3.6 ml/m 2 , p <0.001; CI: 3.4±0.3 vs 1.9±0.3 l/min/m 2 , p <0.001), pulse pressure variation (PPV) increased (13.2±4.3 vs 22.1±4.3%, p <0.001). There was a decrease in oxygen delivery (464±45 vs 246±26.9 ml/min, p <0.001), central venous oxygen saturation (82.8±5.4 vs 53.6±12.1%, p <0.001) and increase in lactate levels (1.6±0.4 vs 3.5±1.6 mmol/l, p <0.005). SVI, CI and PPV returned to their initial values by t 2 . To normalize MAP fluid therapy had to be continued till t 4 , with the total infused volume of 4.5±0.8 l. Conclusion In the current experiment bleeding led to hemorrhagic shock, while MAP remained higher than 65 mmHg. Furthermore, MAP was unable to indicate the normalization of SVI, CI and PPV that resulted in unnecessary fluid administration. Our data give further evidence that MAP may be an inappropriate parameter to follow during fluid resuscitation.