Previously, we have shown improved survival rate with colloid solutions of 2-4% concentration compared to 10% solutions or a colloid-free electrolyte solution, when given in volumes required to maintain the same intravascular volume expansion. This study examines the effect of increasing infusion volumes of Ringer's lactate (RL) and 3% albumin on survival time and blood volume expansion using the lethal intestinal ischemic shock model in rats. Shock was induced by exteriorization of the small intestine with added occlusion of the superior mesenteric vessels for 75 minutes. Untreated animals developed hemoconcentration to 60% in hematocrit (Hct), representing a plasma volume (PV) decrease to 57% of the preshock level. Infusion of 3% albumin increased PV linearly up to 200% above shock levels with infusion volumes of 0-45 ml/100 g bwt. RL increased PV linearly up to 80% above shock baseline level with infusion volumes up to 50 ml/100g. No further PV increase occurred despite increasing volumes of RL. No infusion volume, therefore, of RL restored PV to preshock levels. To achieve the same volume expansion up to 80% above the shock PV levels, 4.4 times larger volume of RL was needed compared to 3% albumin solution. With the same volumes infused (up to 45 ml/100 g), 4-5 times more of the 3% albumin volume infused remained in the vascular space compared to RL. Also, the excreted volume was larger with albumin than with RL, for the same volumes infused. Accordingly, the major portion of the infused RL (60-80%) was located in the extravascular space. No control animals survived 24 hours. Survival time was prolonged with both RL and 3% albumin infusions. The effect on survival time with albumin was obtained with approximately 25% of the fluid required for RL.

Albumins↗

PubMed1985

Colloid solution therapy of experimental ischemic intestinal shock in rats.

This study evaluated the effects of varying colloid concentrations and infusion volumes on survival and plasma volume expansion in rats subjected to an intestinal ischemic shock. Up to 10% solutions of albumin and dextran-40 in lactated Ringer's solution, infused over a 6-h period, had the same effects on hematocrit (Hct) changes and survival patterns. Mean Hct values (45% to 50%) were independent of colloid solution concentration. With lactated Ringer's solution alone, Hct was 55%, despite the very large volume used; and less than 3% of the infused lactated Ringer's solution remained as plasma volume at 3 and 6 h of infusion. With increasing colloid concentration a greater proportion of the infused volume contributed to plasma volume. Of a 10% colloid solution, 50% and 34% remained as plasma volume at 3 and 6 h. For colloid concentrations between 1% and 3%, there was an equal distribution of infused fluid between the extracellular fluid space and the plasma. Survival rate, as measured by blood volume expansion, was greater with colloid solution concentrations between 2% and 4%.

Albumins↗

PubMed1984

Prospective evaluation of renal allograft dysfunction with 99mtechnetium-diethylenetriaminepentaacetic acid renal scans.

A prospective, single-blinded study was done to determine the ability of serial 99mtechnetium-diethylenetriaminepentaacetic acid scans to diagnose renal allograft rejection. Among 28 transplant recipients 111 renal scans were obtained 1 day postoperatively and every 3 to 4 days thereafter for 3 weeks in all patients retaining an allograft. Computer-generated time-activity blood flow curves were analyzed semiquantitatively for the 1) interval between curve peaks of the allograft and iliac artery, 2) renal transit time and 3) renal washout of radionuclide. Excretory function was assessed by degree and interval to appearance of radionuclide in the calices and bladder. Deterioration of renal blood flow and excretion compared to the initial scan was considered rejection. Of 52 scans performed during clinical rejection 47 (90.4 per cent) were interpreted as showing rejection (sensitivity). Of 53 scans interpreted as showing rejection 47 (88.7 per cent) were positive for clinical rejection. The remaining 6 patients (initial false positive results) suffered clinical rejection within 24 to 72 hours. We conclude that 99mtechnetium-diethylenetriaminepentaacetic acid renal scans are useful in the differential diagnosis of renal allograft dysfunction.

Clinical Trials as Topic↗

PubMed1984

Experimental septic shock: relative effects of treatment with antibiotics, crystalloid or colloid solution infusions and corticosteroids.

This study evaluates the relative effects of 2 combined antibiotics, a crystalloid solution, 4 3% colloid solutions, and a pharmacologic dose of corticosteroids, given alone and in combination for the treatment of Escherichia coli-induced septic shock. All treatments began 5.5 h after bacterial injection. Untreated septic rats had a mean survival time of 9.9 h. Antibiotics (trimethophrim and sulfamethoxazole) alone did not significantly increase mean survival time (11.0 h). No rats in either of these two groups survived 24 h. When antibiotics and dexamethasone were combined, 40% (4/10) rats lived longer than 24 h (p less than .05). With Ringer's solution infusion, the mean survival time was 8.7 h and 30% (3/10) lived longer than 24 h. When a 3% colloid solution was given, 50% (20/40) lived more than 24 h and 20% (8/40) lived more than 7 days. There was no significant difference between the 4 colloid solutions (albumin, dextran-40, dextran-70, hydroxyethyl starch). When Ringer's solution was combined with dexamethasone and antibiotics, 80% (8/10) lived more than 24 h and 20% (2/10) were long-term survivors. When the antibiotic drug was combined with a colloid solution and dexamethasone, all animals lived more than 24 h and 90% (9/10) lived more than 7 days. This study demonstrates the therapeutic value of an effective antibiotic drug for control of the infective organism, a colloid solution infusion to maintain blood volume and circulation, and corticosteroids for still largely unknown reasons.

Animals↗

PubMed1982

Relation of colloid concentration to volume expansion for resuscitation of rats subjected to intestinal ischemic shock.

This study was undertaken to determine the volumes of colloids (albumin and dextran 40) with concentrations varying from 0% (Ringer's solution) to 10% solutions required to obtain the same hemodilution. Shock was produced in rats by exteriorization of the small intestine with added complete occlusion of the superior mesenteric vessels with a rubber clamp. After 1 h the clamp was removed, the intestines returned, and the abdomen closed. Over a 6-h period, the fluids were infused continuously in volumes needed to maintain similar hematocrit. Each concentration was given over a wide range of volumes in order to obtain volume-hematocrit curves. Based on these curves, the effect of varying colloid concentration on blood volume expansion was calculated. Albumin and dextran 40 had similar volume expansion/g colloid substance regardless of concentration. When hematocrit of 50% was chosen, as an arbitrary endpoint for volume infusion, the colloid concentration in relation to volume required to be infused is expressed by the equation F50 (formula: see text) where C = colloid concentration and where F50 is the volume factor, or the number of times the volume required for a 10% solution, when a 10% solution is given the volume factor of 1. This relationship is now being used to find the optimal colloid concentration with regard to survival rate in animals subjected to the same intestinal shock.

Albumins↗

PubMed1982

Statistical evaluation of plasma substitutes based on 10 variables.

Inasmuch as no single variable is able to predict the outcome or evaluate the effect of various treatments used for resuscitation of shock, a statistical method was applied to evaluate several plasma substitutes by a numerical system based on 10 different hemodynamic and metabolic variables. Shock was induced in 60 dogs by laparatomy and exteriorization of the small intestines. After 3 h, the intestine was returned and the abdomen closed. Fluid infusion was then given during a 20-min period. Measurements were carried out during the next 4 h. Seven therapeutic agents were studied in 7 groups: control (no infusion); Ringer's acetate; gelatin; dextran-40; dextran-70; ACD-plasma; albumin. Variables included: cardiac output, oxygen consumption, plasma volume, hematocrit, skeletal muscle capillary blood flow and permeability surface area, arterial blood pH and base excess, mean arterial blood pressure, and the extravascular water gain. Dextran-40, dextran-70, and albumin restored an average of 7 variables to values above the preshock median value. Gelatin and plasma restored 4 variables and Ringer's acetate restored 3 variables. When no infusion was given, no variable was restored and the animals remained in shock. It is concluded that 3.5% colloid solutions of dextran-40, dextran-70, and albumin are more effective than plasma, gelatin, and Ringer's acetate in this order.

Animals↗

PubMed1982

Experimental septic shock--effects of corticosteroids.

These studies were undertaken to evaluate the optimal effects of corticosteroids in an experimental septic shock model, with regard to time of therapy institution and the dose of corticosteroids (dexamethasone and methylprednisolone). Septic shock was induced by intraperitoneal injection of 5 x 10(8) live E coli bacteria/100 g body weight. Hematocrit was measured before and 4 h after injection of bacteria. Survival time was recorded continuously for 24 h and then daily for 7 days. Mortality rate correlated with hematocrit increase at 4 h in untreated control animals. Surviving rats did not increase their hematocrit, but nonsurvivors did. Survival time in untreated rats was 9.2 +/- 0.2 h (SEM). Corticosteroids significantly increased survival time when given prophylactically. This effect, however, decreased linearly with time when dexamethasone was given up to 8 h after bacteria injection. Dexamethasone (3-96 mg/kg) and methylprednisolone (19-225 mg/kg) significantly prolonged survival time. Twenty-two percent (73/329) of corticosteroid-treated animals lived longer than 24 h compared to 14% (19/135) of the controls. This difference was of borderline significance (P = 0.05).

Animals↗

PubMed1981

Hemodilution and recovery from experimental intestinal shock in rats: a comparison of the efficacy of three colloids and one electrolyte solution.

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Animals↗

PubMed1981

Hemodilution, oxygen consumption, and recovery from surgical shock. --A study on the efficacy of different plasma substitutes.

The present experiments compare the relative effectiveness of several plasma substitutes to reverse a standardized intestinal ischemic shock in dogs and rats. The colloids were given 3.5% solutions in a dose of 1.5 g/kg = 43 ml/kg for dogs and 2 g/kg = 57 ml/kg for rats.. Ringer's solution was given in a three times larger volume. Colloids of 3.5%, 6%, and 10% concentrations and Ringer's acetate were also given in increasing volumes for a test of the dose, concentration, and volume relationships. Ringer's solution was effective during rapid infusion and for about 30 minutes after the infusion. Gelatin and ACD-plasma was of corresponding effectiveness for 2 hours. Albumin and dextran solutions maintained plasma volume, oxygen consumption for at least 4 hours after the infusion. Colloids were more effective than Ringer's solution at corresponding volumes, and even when three times larger volumes of the latter was given. Colloids of 3.5 and 6% were more effective than a 10% colloid solution. These effects were related to the molecular weight distribution for colloids, the plasma volume expansion duration and their red blood cell aggregation properties. It is concluded that as single infusions albumin, dextran 40, and dextran 70 are superior to ACD plasma, gelatin, and Ringer's acetate in restoring hemodynamic and metabolic functions and in improving survival rate.

Animals↗

PubMed1980

Septic shock.

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Animals↗

PubMed1980

Plasma volume, intravascular protein content, hemodynamic and oxygen transport changes during intestinal shock in dogs. Comparison of relative effectiveness of various plasma expanders.

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Animals↗

PubMed1980

Skeletal muscle microcirculation and oxygenation in experimental intestinal shock: A study on the efficacy of different plasma substitutes.

Shock was induced in 60 dogs by exteriorization of the small intestine for three hours. The relative effectiveness of various hemodiluting agents on the microcirculation was measured as skeletal muscle capillary blood flow (QXe) and capillary permeability (P) surface area (S) for plasma (PSp), as calculated from the clearances of two locally injected isotopes, 133 Xenon and 131 Iodide. Skeletal muscle oxygen tension (Pm(2) was measured with a tissue PO2 electrode. During shock QZe decreased to 26%, PSp to 31% of the initial values, and PmO2 dropped from 51 to 18 mmHg. The degree of recovery from shock was assessed after reposition of the intestine and the infusion of different plasma substitutes (albumin, dextran 40, dextran 70, gelatin, ACD-plasma, and Ringer's acetate). Return of the intestine to the abdominal cavity did not in itself improve the shock condition. Dextran 40 and dextran 70 infusion increased QXe, PSp, and PmO2 to or above control levels, PSp to 60%, and QXe to 40% of the control values. Ringer's acetate gelatin, and ACD-plasma did not improve QXe but increased PSq to 62-67% of control values. Albumin and dextran increased PmO2 significantly in relation to no-fluid infusion. Only dextran 40 and dextran 70 increased both QXe and PSp significantly in relation to no -fluid infusion.

Anesthesia↗

PubMed1979

Oxygen consumption and recovery from surgical shock in rats: a comparison of the efficacy of different plasma substitutes.

Shock was induced in 537 rats by exteriorization of the intestines and occlusion of the superior mesenteric circulation for 1 hour. After 1 hour of this intestinal ischemia shock, oxygen consumption (VO2) decreased to half of the preexperimental values. When no infusion was given, the survival rate at 24 hours was 22%; this was correlated with the degree of restoration of VO2 at 1 hour after shock. VO2 and survival rate improved with infusion of albumin, dextran 40, and dextran 40, and dextran 70. With increasing doses of colloids, both VO2 and survival rate increased; the optimal effect was at the dose of 2 g/kg body weight. When no other therapy was given, colloids at concentrations of 3.5 or 6% solutions had a better effect on survival than the 10% solution. Colloids were more effective than Ringer's acetate when the latter was given in the same volume and up to three times the volume of the colloids.

Animals↗