Splanchnic microcirculation after resuscitation with hypertonic saline in a porcine model of cardiac tamponade

Background

The beneficial effects of hypertonic saline (HS) for resuscitation in hypovolemic shock have long been known, it has also been reports on positive effects of HS on microcirculation in different organ systems. HS is known to increased cardiac output, reduce afterload and blood viscosity, it is also known to improve capillary blood flow by endothelial deswelling. However, there is very few data on the effects of HS on microcirculation in low cardiac output stakes.

Aim

The aim of this study was to investigate the effects of HS on splanchnic microcirculation in a model of cardiac tamponade with subsequent disturbances in splanchnic microcirculatory flow.

Materials and methods

The study design was randomised and crossover. Seven pigs of both sexes, weighing 27–35 kg were included in the study. After induction of anaesthesia all animals were tracheotomized. Central hemodynamics, portal venous blood flow and gastric, hepatic and renal microcirculation were measured simultaneously. Microcirculation was measured with Laser-Doppler technique. Cardiac tamponade was established with infusion of dextran in the pericardium. After stabilization of the tamponade the animals were resuscitated with either HS or Ringer's acetate (4 ml/kg) during 20 min. Changes of perfusion were evaluated with ANOVA and paired comparisons were made by Wilcoxon* P < 0.05 HS versus R-Ac.

Results

There was a significant increase in portal venous flow in the HS group, there was also a significant increase in microcirculatory flow in gastric mucosa, hepatic and renal surface microcirculation in the HS group. Those changes were not present in the R-Ac group. Values in Table are absolute changes by volume resuscitation during cardiac tamponade.

Conclusion

We conclude that HS is beneficial for microcirculation in this model of cardiac tamponade and associated disturbances microcirculatory flow in the splanchnic system. The increase of microcirculatory flow could prevent initialization of inflammatory processes and bacterial translocation and thereby prevent initiation of multi organ failure.

Table are absolute changes