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Initial treatment of shock

Abstract

The aim of this project is to study hypertonic saline solutions (HSS) and oxygen-carrying blood substitutes in the initial management of shock, given that these could elicit hemodynamic, microcirculatory, and cellular benefits capable of reducing the prevalent high post-traumatic mortality rates. Trauma is one of the major world public health problems, being the first cause of mortality for ages between one and 40 years old. Post-traumatic deaths are distributed in three peaks as a function of time. About 50% of these deaths are instantaneous. Virtually nothing can be done for these patients. The second peak of post-traumatic deaths occurs minutes or during the first hours following severe trauma, mainly as a consequence of hemorrhagic shock. Optimal and efficacious initial treatment can substantially reduce these deaths. The third peak is observed weeks after the initial treatment, caused by multiple organs or systems dysfunction and failure, directly related to the speed and efficacy of initial treatment. Therefore post-traumatic shock treatment is the critical determinant factor for reduction of early and late preventable trauma related mortality. Small volumes of hypertonic sodium chloride (7.5% NACI) restore blood pressure, cardiac output, and regional blood flows when injected to animals in severe hemorrhagic shock. In clinical studies of post-traumatic hypotension, benefits were also observed with the use of hypertonic saline solutions, principally for trauma victims requiring surgery for head injury patients with systemic hypotension. Despite extensive laboratorial investigation and considerable clinical experience with hypertonic saline solutions, important clinical aspects remain to be clarified as well as controversies that will be evaluated in this project. (AU)

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Scientific publications (9)
(References retrieved automatically from Web of Science and SciELO through information on FAPESP grants and their corresponding numbers as mentioned in the publications by the authors)
GARRIDO‚ A.P.G.; CRUZ‚ R.J.; DE FIGUEIREDO‚ L.F.P.; E SILVA‚ M.R. Small volume of hypertonic saline as the initial fluid replacement in experimental hypodynamic sepsis. CRITICAL CARE, v. 10, n. 2, p. R62, 2006.
RUY JORGE CRUZ JUNIOR; MARGARETH M. YADA-LANGUI; ALEJANDRA GALLARDO GARRIDO; LUIZ FRANCISCO POLI DE FIGUEIREDO; MAURICIO ROCHA E SILVA. Efeitos iniciais da reposição volêmica com solução salina hipertônica a 7,5% na perfusão e oxigenação esplâncnica após choque hemorrágico. Acta Cirurgica Brasileira, v. 21, n. 2, p. 106-112, Abr. 2006.
A.G. GARRIDO; L.F. POLI DE FIGUEIREDO; R.J. CRUZ JR.; E. SILVA; M. ROCHA E SILVA. Short-lasting systemic and regional benefits of early crystalloid infusion after intravenous inoculation of dogs with live Escherichia coli. Brazilian Journal of Medical and Biological Research, v. 38, n. 6, p. 873-884, Jun. 2005.
YADA-LANGUI, MARGARETH M.; ANJOS-VALOTTA, EDNA A.; SANNOMIYA, PAULINA; SILVA, MAURÍCIO ROCHA E; COIMBRA, RAUL. Resuscitation affects microcirculatory polymorphonuclear leukocyte behavior after hemorrhagic shock: role of hypertonic saline and pentoxifylline. Experimental Biology and Medicine, v. 229, n. 7, p. 684-693, July 2004.
CRUZ JR‚ RJ; POLI DE FIGUEIREDO‚ LF; BRAS‚ JLM; ROCHA E SILVA‚ M. Effects of Intra-Aortic Balloon Occlusion on Intestinal Perfusion‚ Oxygen Metabolism and Gastric Mucosal PCO2 during Experimental Hemorrhagic Shock. EUROPEAN SURGICAL RESEARCH, v. 36, n. 3, p. 172-178, 2004.
DE FIGUEIREDO‚ L.F.P.; CRUZ JR‚ R.J.; SILVA‚ E.; ROCHA E SILVA‚ M. Cardiac output determination during experimental hemorrhage and resuscitation using a transesophageal Doppler monitor. ARTIFICIAL ORGANS, v. 28, n. 4, p. 338-342, 2004.
RUY JORGE CRUZ JUNIOR; CRISTIANO DE JESUS CORREIA; LUIZ FRANCISCO POLI DE FIGUEIREDO; MAURÍCIO ROCHA E SILVA. Efeitos hemodinâmicos e metabólicos iniciais da perfusão hipotérmica intestinal in situ.: avaliação de um novo modelo canino de autotransplante intestinal. Acta Cirurgica Brasileira, v. 19, n. 4, p. 383-392, Ago. 2004.
DE FIGUEIREDO‚ L.F.P.; CRUZ JR‚ R.J.; NETO‚ A.C.; YADA-LANGUI‚ M.M.; E SILVA‚ M.R. Initial Management of Severe Hemorrhage with an Oxygen-Carrying Hypertonic Saline Solution. ARTIFICIAL ORGANS, v. 25, n. 11, p. 922-927, 2001.
DE FIGUEIREDO‚ L.F.P.; NELSON‚ S.H.; MATHRU‚ M.; E SILVA‚ M.R.; KRAMER‚ G.C. Effects of Hemoglobin-Based Blood Substitutes on Vasoactivity of Rat Aortic Rings. ARTIFICIAL ORGANS, v. 25, n. 11, p. 928-933, 2001.

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