Goal-directed fluid therapy based on the continuous left ventricle end-diastolic volume improves acute mesenteric ischemia/reperfusion injury in rats

Introduction

Fluid infusion is an essential part of proper medical and surgical management. The target hemodynamic parameters for goal-directed fluid therapy remain controversial, with concerns regarding the risk of overhydration. We used a splanchnic ischemia–reperfusion (I/R) model with a high mortality rate to test whether fluid infusion aimed to target constant left ventricular end-diastolic volume (LVEDV) would ameliorate physiologic and biologic parameters in this situation.

Methods

Two groups of adult rats were subjected to 90 minutes of mesenteric ischemia followed by 150 minutes of reperfusion, with one group (I/R+Vol) receiving fluids (one-half glucose 5% and one-half Isohes^®) to maintain the LVEDV at baseline levels during reperfusion, and the other group (I/R) receiving no extra fluids. A sham group (instrumented without I/R) served as controls.

Results

In spite of a persisting acidosis, the LVEDV-directed fluid therapy was able to prevent the rapid fatal outcome, without evidence of overhydration (Figure 1), as demonstrated by the absence of an increased lung wet/dry weight ratio.

Figure 1

abstract P232

Conclusion

Early LVEDV-directed fluid therapy markedly improves the outcome from mesenteric I/R injury.