The influence of different resuscitation solution on lactic acid accumulation after hemorrhagic shock: a network meta-analysis

X.-Q. Wu, Z.-B. Li, W.-X. Chen, D.-L. Wen, Z.-H. Zhang, X.-M. Xiong

Department of Critical Care Medicine, Guangzhou First People’s Hospital, Guangzhou, China. wendeliang@tutanota.com

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• Pharmacology

OBJECTIVE: To compare the effect of various fluid resuscitation procedures after hemorrhagic shock on the lactic acid accumulation by network meta-analysis.
MATERIALS AND METHODS: A number of articles were obtained by searching the databases. Randomized control trials (RCT) were selected by two literature quality assessors; the extracted experimental data were then summarized to compare and analyze the effect of various kinds of infusion procedures at different time points on the concentration of lactic acid in the internal environment of rat models.
RESULTS: 9 articles containing 25 independent reports were enrolled. Results revealed that the accumulation of lactic acid generated in the resuscitation using hydroxyethyl starch solution or gelofusine was significantly different from the one using Ringer solution, hypertonic saline or normal salt solution (p<0.05). Compared to the colloidal, the aqueous solution of pyruvate showed a slightly weaker effect in reducing the accumulation of lactic acid. The accumulation of lactic acid is severely affected by hypertonic saline, Ringer lactate solution, and balanced salt solution, i.e., the concentration of lactic acid is increasing with an augment of concentration or prolongation of treatment time.
CONCLUSIONS: In terms of the management of lactic acid accumulation after hemorrhagic shock, the effect of colloidal solution was remarkably better than a crystalloid solution, and hypertonic saline and normal salt solution were not recommended as preferable drugs in the treatment of hemorrhagic shock.

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