Resuscitation of hemorrhagic shock using normal saline does not damage the glycocalyx in the immediate resuscitation phase
Antonius Hocky Pudjiadi1, Agus Firmansyah1, DV M. Gunanti Soeyono2, Saptawati Bardosono3, Sri Widia Jusman4, Minarma Siagian5, Munar Lubis6
1 Department of Child Health, Faculty of Medicine, Cipto Mangunkusumo Hospital, Universitas Indonesia, Jakarta, Indonesia
2 Department of Veterinary Clinic Reproduction and Pathology, Division of Veterinary Surgery and Radiology, Faculty of Veterinary Medicine, Bogor Agricultural University, Bogor, Indonesia
3 Department of Nutrition, Universitas Indonesia, Jakarta, Indonesia
4 Department of Biochemistry and Molecular Biology, Universitas Indonesia, Jakarta, Indonesia
5 Department of Physiology, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
6 Department of Child Health, North Sumatera University Hospital, Faculty of Medicine North Sumatera University, Medan, Indonesia
Keywords: Atrial natriuretic factor, extravascular lung water, hypervolemic hemodilution, oxygen delivery, syndecan-1
OBJECTIVES: The objectives were to study the effect of aggressive resuscitation using normal saline on hemodynamics, serum atrial natriuretic peptide (ANP), syndecan-1 (marker of endothelial glycocalyx shedding), and extravascular lung water index (ELWI) following hemorrhagic shock.
METHODS: Eleven male piglets (Sus scrofa) underwent blood drawing to create 20% drop in mean arterial pressure (MAP). Two-phase resuscitation was performed: Phase 1 using normal saline of an equal volume of blood drawn to create shock and Phase 2 using 40 ml/kg BW of normal saline to simulate hypervolemia and hemodilution. Heart rate, MAP, cardiac index (CI), systemic vascular resistance index, oxygen delivery (DO2), global end-diastolic volume index, ELWI, hemoglobin (Hb), lactate, ANP, and syndecan-1 at each phase and up to 60 min following Phase 2 resuscitation were recorded.
RESULTS: Phase 2 resuscitation significantly decreased Hb concentration (P = 0.006), however, DO2 was maintained (P = 1.000). CI increased from shock to Phase 1 (P = 0.029) and further increase in Phase 2 resuscitation (P = 0.001). Overall, there was a transient increase of ANP following Phase 1 resuscitation, from 85.20 ± 40.86 ng/L at baseline to 106.42 ± 33.71 ng/L (P = 0.260). Serum syndecan-1 and ELWI change at all phases were not significant.
CONCLUSIONS: We demonstrate compensatory protective mechanism despite overzealous fluid resuscitation. Compensatory increased CI despite decreased Hb maintained DO2. In the absence of inflammation, serum ANP did not increase significantly, no glycocalyx shedding occurred, subsequently no change in ELWI. We show that factors other than volume overload are more dominant in causing glycocalyx shedding.
This study obtained ethical approval from the Animal Ethical Committee of Faculty of Veterinary Medicine, Bogor Agricultural University, Bogor, with ethical approval number 055/KEH/SKE/ III/2017, at July 3, 2017.
AHP: conception and study design, data acquisition, analysis and interpretation, drafted and critically revised the work. AF: conception, data analysis, critically revised the work. GS: study design, data acquisition, drafting the work. SB: conception, data analysis and interpretation, drafted the work. SWJ: study design, data analysis, drafted the work. MS: study design, data analysis, drafted the work. ML: study design, data analysis, drafted the work. All of the authors have approved the submitted version and have agreed both to be personally accountable for the author’s own contributions and to ensure that questions related to the accuracy or integrity of any part of the work, even ones in which the author was not personally involved, are appropriately investigated, resolved, and the resolution documented in the literature.