Zur Wirkung von Vasopressin beim unkontrollierten hämorrhagischen Schock

Vasopressor Agents or Fluid Resuscitation for the Treatment of
Uncontrolled Hemorrhagic Shock, an Experimental Approach in a
Porcine Liver Trauma Model The standard approach to the traumatized
victim in uncontrolled hemorrhagic shock is to infuse large amounts
of crystalloid and colloid fluids as early, and as rapidly as
possible. The aim of this strategy is to restore intravascular
volume immediately and to maintain vital organ perfusion. The
results of many laboratory studies and one clinical trial question
the effectiveness of this treatment recommendation and suggest that
in the case of uncontrolled hemorrhage aggressive fluid
resuscitation may even be harmful. Hence, we evaluated the effects
of fluid resuscitation vs. epinephrine vs. vasopressin vs. saline
placebo on hemodynamic variables, regional organ blood flow, and
short term survival in an animal model of uncontrolled hemorrhagic
shock. Twenty-eight anesthetized pigs were subjected to a severe
liver injury, which resulted in an average blood loss of 35 mL/kg
within 30 minutes. When mean arterial pressure was < 20 mmHg,
and heart rate declined progressively, the pigs were randomly
assigned to receive either 1000 mL lactated Ringer´s solution and
1000 mL of gelatine solution (n=7), or an intravenous bolus dose
and continuous infusion of 45 µg/kg epinephrine (n=7), or 0.4 IU/kg
Vasopressin (n=7), or saline placebo (n=7). At 30 minutes after
therapeutic intervention all surviving animals have been fluid
resuscitated and further blood loss has been controlled surgically.
Mean ± SEM arterial blood pressure at 5 minutes after therapeutic
intervention was significantly (p< 0.0001 for vasopressin vs.
epinephrine vs. placebo and p< 0.04 for vasopressin vs. fluid
resuscitation) higher after vasopressin vs. fluid resuscitation vs.
epinephrine vs. saline placebo (58 ± 9 vs. 32 ± 6 vs. 19 ± 5 vs. 7
± 3 mmHg; respectively). Although vasopressin improved regional
organ blood flow, this effect did not result in further blood loss
stemming from the liver injury (vasopressin vs. fluid resuscitation
vs. epinephrine vs. saline placebo 10 minutes after intervention,
1343 ± 60 vs. 2536 ± 93 vs. 1383 ± 117 vs. 1326 ± 46 mL;
respectively; p