Advantages of dextran 70 over Ringer acetate solution in shock treatment and in prevention of adult respiratory distress syndrome. A randomized study in man after traumatic-haemorrhagic shock

Abstract

Twenty-three patients aged 20-58 years in a serious state of shock and suffering from major pelvic and femoral fractures sustained in traffic accidents were studied. As initial fluid management, either dextran 70 (1000-1500 ml) together with Ringer's acetate solution (2000-3000 ml), or Ringer's acetate alone (5000-8000 ml), was administered on a random basis. Thus, 12 patients received dextran and 11 patients crystalloid treatment to counteract shock. Both groups were given whole blood. The resuscitation time--i.e. the interval from the start of fluid therapy until a stable circulatory condition was achieved--was significantly shorter (P less than 0.001) in the dextran group (108 +/- 18 min; mean +/- S.D.) than in the Ringer group (170 +/- 43 min). During the post-resuscitative observation period of 6 days the dextran patients were given 500 ml of dextran daily, while the Ringer group did not receive any colloidal solution. To maintain a stable circulation and a urinary output above 50 ml/h the Ringer patients required significantly more (P less than 0.001) crystalloid solution (910 +/- 300 ml) daily than the dextran patients (460 +/- 400 ml). The frequency of adult respiratory distress syndrome (ARDS) was significantly lower (P less than 0.05) in the dextran group (0 of 12) than in the Ringer group (4 of 11). Thus, in the initial treatment of traumatic-haemorrhagic shock and in the post-resuscitative period dextran 70 would seem of advantage over Ringer's acetate both in shortening the shock period and in reducing the frequency of adult respiratory distress syndrome.