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Early Vasopressin Improves Short-Term Survival after Pulmonary Contusion

Feinstein, Ara J. MD; Cohn, Stephen M. MD, FACS; King, David R. MD; Sanui, Masamitsu MD; Proctor, Kenneth G. PhD

The Journal of Trauma: Injury, Infection, and Critical Care: October 2005 - Volume 59 - Issue 4 - p 876-883
doi: 10.1097/01.ta.0000187654.24146.22
Original Articles
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Arginine vasopressin (AVP) is a promising treatment for several types of irreversible shock, but its therapeutic potential has not been examined after severe chest trauma. Two series of experiments were performed to fill this gap

Methods: Series 1: anesthetized, mechanically-ventilated pigs (n = 20, 29 ± 1 kg) received a blast to the chest, followed by a “controlled” arterial hemorrhage to a mean arterial pressure (MAP) <30 mm Hg. At 20 minutes, a 10 mL/kg normal saline (NS) bolus was followed by either 0.1 U/kg AVP bolus or NS, in randomized, blinded fashion. From 30-300 minutes, either AVP (0.4U/kg/hr plus NS) or NS alone was infused as needed to MAP>70 mm Hg. Series 2: Swine (n = 15) received the chest injury followed by partial left hepatectomy to produce “uncontrolled” hemorrhage. Resuscitation was the same as in series 1

Results: The blast created bilateral parenchymal contusions (R > L), hemo/pneumothorax and progressive cardiopulmonary distress. In Series 1, there were 3/20 deaths before randomization, 0/8 deaths after resuscitation with AVP versus 4/9 deaths with NS (p = 0.029). In surviving animals, with AVP versus NS, fluid requirements and peak airway pressures were lower while P/F was higher (all p < 0.05). In Series 2, with uncontrolled hemorrhage, there were 5/15 deaths before randomization. Upon resuscitation with AVP versus NS, survival time and blood loss were both improved, but the differences did not reach statistical significance

Conclusions: After severe chest trauma with controlled hemorrhage, early AVP decreased mortality, reduced fluid requirements and improved pulmonary function. With uncontrolled hemorrhage, early AVP did not increase the risk for bleeding.

From the Dewitt Divisions of Trauma and Surgical Critical Care, Daughtry Family Department of Surgery, University of Miami Miller School of Medicine

Submitted for publication May 3, 2005.

Accepted for publication August 5, 2005.

Supported by: Grants # N000140210339, #N000140210035 from the Office of Naval Research, and # T32 GM08749-01 from the NIH-GMS

Presented at the Resident Paper Competition, Eastern Association of Trauma 18th Annual Scientific Assembly, Fort Lauderdale Florida, January 13th, 2005.

Address for reprints: Kenneth G. Proctor, Ph.D., Divisions of Trauma and Surgical Critical Care, Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Ryder Trauma Center, 1800 NW 10th Ave. Miami, FL 33136; email: kproctor@miami.edu.

© 2005 Lippincott Williams & Wilkins, Inc.