Reposición de Volumen y Hemorragia

The Resuscitative Fluid You Choose May Potentiate Bleeding.
Journal of Trauma-Injury Infection & Critical Care. 61(6):1350-1358, December 2006.Brummel-Ziedins, Kathleen PhD; Whelihan, Matthew F. BS; Ziedins, Eduards G. MD; Mann, Kenneth G. PhD

Background: Trauma is the leading cause of death in the younger population in the United States, frequently from the development of hemorrhagic shock. Controversy exists over the type of volume resuscitation for restoring hemodynamic stability that should be used in hemorrhagic shock. Little is known about how various resuscitative paradigms affect the coagulation cascade, which is essential to controlling hemorrhagic shock.

Methods: We studied the effect of various resuscitative formulas on blood coagulation using a new model of whole blood in a controlled setting with corn trypsin inhibitor and a 5-pM stimulus of tissue factor. We investigated thrombin generation, fibrin formation, and platelet activation with four diluents: 0.9% NaCl (NS), lactated Ringer's solution (LR), 6% hydroxyethyl starch (HES), and 3% NaCl (HS), each from 0% to 75% blood dilution. Thrombin generation was measured periodically during a time course of 20 minutes in its complex with antithrombin III. Platelet activation and fibrinopeptide A (FPA) release were monitored in serum at a 20-minute time point. Fibrin clots were collected and weighed.

Results: The coagulation markers (thrombin generation, platelet activation, and FPA release) were significantly different by dilution (p <>30% dilutions, HS produced no stable clots and HES dramatically decreased clot formation by 61% and maintained this level.

Conclusions: LR and NS had the least effect on thrombin generation, clot formation, and platelet activation at various concentrations compared with HES and HS. This observational data suggests that volume expanders such as HES and HS may be detrimental in treatment of hemorrhagic shock.