Searching for the optimal fluid to restore microcirculatory Flowdynamics after haemorrhagic shock: a systematic review of preclinical studies

Naumann, David N., Beaven, Alastair, Dretzke, Janine, Hutchings, Sam and Midwinter, Mark J. (2016) Searching for the optimal fluid to restore microcirculatory Flowdynamics after haemorrhagic shock: a systematic review of preclinical studies. Shock, 46 6: 609-622. doi:10.1097/SHK.0000000000000687


Author Naumann, David N.
Beaven, Alastair
Dretzke, Janine
Hutchings, Sam
Midwinter, Mark J.
Title Searching for the optimal fluid to restore microcirculatory Flowdynamics after haemorrhagic shock: a systematic review of preclinical studies
Journal name Shock   Check publisher's open access policy
ISSN 1540-0514
1073-2322
Publication date 2016-12-01
Sub-type Critical review of research, literature review, critical commentary
DOI 10.1097/SHK.0000000000000687
Open Access Status Not yet assessed
Volume 46
Issue 6
Start page 609
End page 622
Total pages 14
Place of publication Philadelphia, PA, United States
Publisher Lippincott Williams & Wilkins
Language eng
Formatted abstract
Background: Increased microcirculatory flow and perfusion has been reported to improve clinical outcomes following shock. The optimal resuscitation fluid to restore the flow dynamics of the microcirculation is unknown. This review summarizes the preclinical literature to inform the direction and most important hypotheses for future clinical interventional studies.

Methods: Standard systematic review methodology was utilized, and registered with the Collaborative Approach to Meta Analysis and Review of Animal Data from Experimental Studies (CAMARADES). Medline and Embase (via OVID SP) and SCOPUS were searched for all preclinical studies of haemorrhagic shock that compared fluid resuscitation of any kind (e.g., blood products, crystalloids, colloids, or haemoglobin based oxygen carriers) to another fluid or haemorrhage only, and reported at least one microcirculatory physical endpoint (such as flow rate, velocity, vessel diameter, functional capillary density, or glycocalyx thickness). Risk of bias was assessed using the Systematic Review Centre for Laboratory animal Experimentation (SYRCLE) tool. Translatability was also assessed for each study based on the most common recommendations.

Results: There were 3,103 potential studies of interest, of which 71 studies fulfilled all eligibility criteria. There were 62 rodent, 5 canine, and 4 porcine studies. Flow rate, velocity, and vessel diameter were the most commonly reported endpoints. Studies reported the importance of the presence of haemoglobin, as well as osmotic potential and viscosity in providing optimal restoration of microcirculatory flow dynamics. Others reported the restoration of the endothelial glycocalyx and attenuation of inflammation as important properties for the choice of fluid. All studies were at potential risk of bias due to unclear randomization, concealment, and blinding. There were important threats to translatability for all studies.

Conclusion: The ideal resuscitation fluid for restoration of the microcirculation following haemorrhagic shock is likely to contain a preparation of haemoglobin, favor higher oncotic potential, and viscosity, protect and reconstitute the endothelium, and attenuate inflammation. These hypotheses that are derived from preclinical research warrant further exploration in the clinical context.
Keyword Haemorrhagic shock
Microcirculation
Preclinical
Resuscitation
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status Non-UQ

Document type: Journal Article
Sub-type: Critical review of research, literature review, critical commentary
Collection: School of Medicine Publications
 
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