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Sun, 09 Mar 2003 12:06:24 -0500

I do not have access to the article.

The abstract does not mention the flow rate for the saline placebo. Is it
considered to be TKO?

The survival is stated to be greater than 7 days, but the conclusion
states "survival with full recovery." Since 1 died in the vasopressin
group, how do they determine "full recovery?" Anyone willing to volunteer
for human studies?

Is there something about the liver injury that is more responsive to
vasopressin therapy?

Will further research be designed to confirm these results, or to seek an
optimal dose of vasopressin?

How might this affect treatment of non-hemorrhagic shock?

Sponsored by a bank (would that be a blood bank)?

Tim Noonan.

On Sat, 8 Mar 2003 18:59:12 -0500, "Leo I. Stemp, MD"
<leos@cox.net> said:
> Impressive animal study.  This study would suggest that if volume
> resusc in uncontrolled hemorrhage increases morbidity, it is NOT via an
> elevation in the BP.  Referring to other studies also, the authors
> suggest that vasopressin has benefit in this situation, compared to
> catachol vasopressors.
>
> Vasopressin, but Not Fluid Resuscitation, Enhances Survival in a
> Liver Trauma Model with Uncontrolled and Otherwise Lethal Hemorrhagic
> Shock in Pigs
>
> Anesthesiology 2003; 98(3):699-704
>
> Karl H. Stadlbauer, M.D. *; Horst G. Wagner-Berger, M.D. *; Claus
> Raedler, M.D. *; Wolfgang G. Voelckel, M.D. *; Volker Wenzel, M.D. *;
> Anette C. Krismer, M.D. *; Guenter Klima, M.D. =86; Klaus Rheinberger,
> M.Sc. *; Walter Nussbaumer, M.D. =87; Daniel Pressmar, B.S. *; Karl H.
>   Lindner, M.D. *; Alfred K=F6nigsrainer, M.D. =A7
>
> Departments of *Anesthesiology and Critical Care Medicine, =86Histology,
> =87Transfusion Medicine, and =A7Surgery, Leopold-Franzens-University.
>
> Background: The authors compared the effects of vasopressin versus
> fluid resuscitation on survival in a liver trauma model with
> uncontrolled and otherwise lethal hemorrhagic shock in pigs.
>
> Methods: A midline laparotomy was performed on 23 domestic pigs,
> followed by an incision, and subsequent finger fraction across the
> right medial liver lobe. During hemorrhagic shock, animals were
> randomly assigned to receive either 0.4 U/kg vasopressin (n =3D 9), or
> fluid resuscitation (n =3D 7), or saline placebo (n =3D 7), respectively.=
 A
> continuous infusion of 0.08 U =B7 kg-1 =B7 min-1 vasopressin in the
> vasopressin group, or normal saline was subsequently administered in
> the fluid resuscitation and saline placebo group, respectively. After
> 30 min of experimental therapy, bleeding was controlled by surgical
> intervention, and blood transfusion and rapid fluid infusion were
> subsequently performed.
>
> Results: Maximum mean arterial blood pressure during experimental
> therapy in the vasopressin-treated animals was significantly higher
> than in the fluid resuscitation and saline placebo groups (mean =B1
> SD, 72 =B1 26
> vs. 38 =B1 16 vs. 11 =B1 7 mmHg, respectively; P < 0.05). Subsequently,
>     mean arterial blood pressure remained at approximately 40 mmHg in
>     all vasopressin-treated animals, whereas mean arterial blood
>     pressure in all fluid resuscitation and saline placebo pigs was
>     close to aortic hydrostatic pressure (~15 mmHg) within
>     approximately 20 min of experimental therapy initiation. Total
>     blood loss was significantly higher in the fluid resuscitation pigs
>     compared with vasopressin or saline placebo after 10 min of
>     experimental therapy (65 =B1 6 vs. 42 =B1 4
> vs. 43 =B1 6 ml/kg, respectively; P < 0.05). Seven of seven fluid
>     resuscitation, and seven of seven saline placebo pigs died within
>     approximately 20 min of experimental therapy, while 8 of 9
>     vasopressin animals survived more than 7 days (P < 0.05).
>
> Conclusions: Vasopressin, but not fluid resuscitation or saline
> placebo, ensured survival with full recovery in this liver trauma model
> with uncontrolled and otherwise lethal hemorrhagic shock in pigs.
>
> Leo Stemp
>
> ----------------------------
>
> Leo I. Stemp, MD Mercy Medical Center Intensive Care Unit 271 Carew
> Street Springfield, MA  01102
> (413)748-9860 leos@cox.net
>
>
> From: "Cotton, Chris (SAAS)" <cotton.chris@saambulance.com.au> Subject:
> lethal hemorrhagic shock in pigs - vasopressin versus...
>
> Leo, Who sponsored the study? Overall ... interesting ramifications for
> the promoters of permissive hypotension.
>
> Chris Cotton

> Sponsored by some bank, and internal funding.  No drug co. funding.

> Interesting ramifications for management of such pts in the field.
> Perhaps paramedics in the future will be infusing vasopressin to pts in
> shock during transport, roughly titrated to some end point such as a
> MAP of 50-60.

> Leo

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