A pilot comparison of limited versus large fluid volume resuscitation in canine spontaneous hemoperitoneum.

Treatment for hemorrhagic shock secondary to a spontaneous hemoperitoneum includes restoration of IV volume and surgical control of hemorrhage. This study was designed to determine if limited fluid volume resuscitation (LFVR) with hypertonic saline (HS) and hyperoncotic fluids (hydroxyethylstarch [HES]) results in more rapid cardiovascular stabilization in dogs with spontaneous hemoperitoneum versus conventional resuscitation (CR) with large volume resuscitation. Eighteen client-owned dogs presenting in hemorrhagic shock with a spontaneous hemoperitoneum were enrolled. Dogs were randomized to be fluid resuscitated with up to 90 mL/kg of an isotonic crystalloid (CR group) or up to 8 mL/kg of 7.2% Na chloride (i.e., HS) combined with up to 10 mL/kg of 6% HES. Measurements of vital signs, lactate, packed cell volume (PCV), total solids (TS), and blood pressure were made at standard time points. The primary end point was time to stabilization of hemodynamic parameters (measured in min). Dogs in the LFVR group achieved hemodynamic stabilization significantly faster (20 min; range, 10-25 min) than those in the CR group (35 min; range, 15-50 min; P = .027). Future studies are warranted to further investigate potential benefits associated with LFVR in dogs with spontaneous hemoperitoneum.

Injectable polyHIPEs as high-porosity bone grafts.

Polymerization of high internal phase emulsions (polyHIPEs) is a relatively new method for the production of high-porosity scaffolds. The tunable architecture of these polyHIPE foams makes them attractive candidates for tissue engineered bone grafts. Previously studied polyHIPE systems require either toxic diluents or high cure temperatures which prohibit their use as an injectable bone graft. In contrast, we have developed an injectable polyHIPE that cures at physiological temperatures to a rigid, high-porosity foam. First, a biodegradable macromer, propylene fumarate dimethacrylate (PFDMA), was synthesized that has appropriate viscosity and hydrophobicity for emulsification. The process of surfactant selection is detailed with particular focus on the key structural features of both polymer (logP values, hydrogen bond acceptor sites) and surfactant (HLB values, hydrogen bond donor sites) that enable stable HIPE formation. Incubation of HIPEs at 37 °C was used to initiate radical cross-linking of the unsaturated double bond of the methacrylate groups to polymerize the continuous phase and lock in the emulsion geometry. The resulting polyHIPEs exhibited ~75% porosity, pore sizes ranging from 4 to 29 µm, and an average compressive modulus and strength of 33 and 5 MPa, respectively. These findings highlight the great potential of these scaffolds as injectable, tissue engineered bone grafts.

Limited fluid volume resuscitation.

Volume replacement therapy is crucial to the treatment of hypovolemic shock. In patients with certain conditions, limiting the volume of fluid administered has many potential therapeutic benefits and technical advantages. Hypertonic saline and colloids have characteristics that allow effective treatment of hypovolemic shock using relatively smaller volumes than would be required for isotonic crystalloids alone. This article describes the theory and clinical application of limited fluid volume resuscitation in veterinary medicine.

Biodegradable fumarate-based polyHIPEs as tissue engineering scaffolds.

PolyHIPEs show great promise as tissue engineering scaffolds due to the tremendous control of pore size and interconnectivity afforded by this technique. Highly porous, fully biodegradable scaffolds were prepared by polymerization of the continuous phase of high internal phase emulsions (HIPEs) containing the macromer poly(propylene fumarate) (PPF) and the cross-linker propylene fumarate diacrylate (PFDA). Toluene was used as a diluent to reduce the viscosity of the organic phase to enable HIPE formation. A range of polyHIPE scaffolds of different pore sizes and morphologies were generated by varying the diluent concentration (40-60 wt %), cross-linker concentration (25-75 wt %), and macromer molecular weight ( M n = 800-1000 g/mol). Although some formulations resulted in macroporous monoliths (pore diameter >500 microm), the majority of the polyHIPEs studied were rigid, microporous monoliths with average pore diameters in the range 10-300 microm. Gravimetric analysis confirmed the porosity of the microporous monoliths as 80-89% with most scaffolds above 84%. These studies demonstrate that emulsion templating can be used to generate rigid, biodegradable scaffolds with highly interconnected pores suitable for tissue engineering scaffolds.