Infusion volumes of Ringer's lactate and 3% albumin solution as they relate to survival after resuscitation of a lethal intestinal ischemic shock

Previously, we have shown improved survival rate with colloid solutions of 2-4% concentration compared to 10% solutions or a colloid-free electrolyte solution, when given in volumes required to maintain the same intravascular volume expansion. This study examines the effect of increasing infusion volumes of Ringer's lactate (RL) and 3% albumin on survival time and blood volume expansion using the lethal intestinal ischemic shock model in rats. Shock was induced by exteriorization of the small intestine with added occlusion of the superior mesenteric vessels for 75 minutes. Untreated animals developed hemoconcentration to 60% in hematocrit (Hct), representing a plasma volume (PV) decrease to 57% of the preshock level. Infusion of 3% albumin increased PV linearly up to 200% above shock levels with infusion volumes of 0-45 ml/100 g bwt. RL increased PV linearly up to 80% above shock baseline level with infusion volumes up to 50 ml/100 g. No further PV increase occurred despite increasing volumes of RL. No infusion volume, therefore, of RL restored PV to preshock levels. To achieve the same volume expansion up to 80% above the shock PV levels, 4.4 times larger volume of RL was needed compared to 3% albumin solution. With the same volumes infused (up to 45 ml/100 g), 4-5 times more of the 3% albumin volume infused remained in the vascular space compared to RL. Also, the excreted volume was larger with albumin than with RL, for the same volumes infused. Accordingly, the major portion of the infused RL (60-80%) was located in the extravascular space. No control animals survived 24 hours. Survival time was prolonged with both RL and 3% albumin infusions. The effect on survival time with albumin was obtained with approximately 25% of the fluid required for RL.