12/29/2022 0 Comments Jmicrovision download![]() Historically, 3- to 4-fold ratio is recommended in various textbooks as a traditional approach to counterweigh blood loss. This ambiguity arises from the lack of evidence-based recommendations with regard to the volume of crystalloid solution to be administered in order to compensate for the same blood lost volume. Despite the routine use of crystalloids in these clinical situations, the optimal volume to be administered to re-establish blood volume and maintain optimal cardiac output and end-organ perfusion is arbitrary. There are various clinical situations where continuous and occult bleeding (such as liver surgery and trauma, transplants, scoliosis surgery, etc.) may occur and the clinicians may have to face higher ratio of fluid replacement to maintain hemodynamic stability. However, crystalloids have short hemodynamic beneficial effect due to the extravasation into the interstitial space with a very low (less than 20%) intravascular volume effect. The main feature of this strategy is to reduce the amount of fluid administered to the patients while maintaining optimal cardiac output and adequate organ perfusion. Moreover, goal-directed fluid therapy is now a well-established strategy in routine clinical practice in the perioperative period. With the increased awareness of the potential harmful effect of colloids on the organs, crystalloids are considered as first line fluid resuscitation therapy. Therefore, considering this ratio promotes the restrictive fluid administration in the presence of continuous and occult bleeding. Conclusionsįluid resuscitation therapy by administering a 1:1 blood replacement ratio revealed adequate compensation capacity and physiological homeostasis similar with no lung stiffening and pulmonary edema. Lung edema was noted in Group 3 ( p < 0.05). No differences in MAP or HR were present between Groups 1 and 3. H elevated in all groups ( p < 0.02), with significantly higher changes in Group 3 compared to Groups C and 1 (both p = 0.03). Raw decreased in Groups 1 and 3 following CR3 ( p < 0.02) without differences between the groups. Lung edema index was measured from histological samples. Airway resistance (Raw), respiratory tissue damping (G) and tissue elastance (H), mean arterial pressure (MAP) and heart rate (HR) were assessed following each step of fluid replacement with a crystalloid (CR1-CR6). ![]() Arterial blood of 5% of the total blood volume was withdrawn 7 times, and replaced stepwise with different volume rations of Ringer’s acetate, according to group assignments. MethodsĪnesthetized, ventilated rats randomly included in 3 groups: blood withdrawal and replacement with crystalloid in 1:1 ratio (Group 1, n = 11), traditional 1:3 ratio (Group 3, n = 12) and a control group with no interventions (Group C, n = 9). Therefore, we aimed at comparing the systemic hemodynamic and respiratory effects of volume replacement therapy with a 1:1 ratio to the historical 1:3 ratio. Crystalloids are first line in fluid resuscitation therapy, however there is a lack of evidence-based recommendations on the volume to be administered. ![]()
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