Hyperpressure Intraperitoneal Fluid Administration for Control of Bleeding after Liver Injury Siavash Ahmadi-noorbakhsh, D.V.M., Saeed Azizi, D.V.M., D.V.Sc., 1 Bahram Dalir-Naghadeh, D.V.M., D.V.Sc., and Masoud Maham, D.V.M., D.V.Sc. Department of Clinical Sciences, Faculty of Veterinary Medicine, Urmia University, Urmia, Iran Originally submitted May 16, 2011; accepted for publication October 6, 2011 Background. Acute hemorrhage is the principal cause of death in trauma patients, with most fatalities occurring during the pre-hospital phase. Recently, intra-abdominal insufflation by carbon dioxide has been shown to drastically reduce bleeding in vascular and splanchnic hemorrhagic animal models simulat- ing the pre-hospital phase. Here, we propose that using dialysate fluid for increasing intra-abdominal pres- sure is at least as effective as gas with some potential advantages. Materials and Methods. A novel method of inducing liver trauma was used in 24 White New Zealand rab- bits randomized into three groups: intra-abdominal carbon dioxide insufflation (GAS) with 15 cm H 2 O pressure; intra-abdominal infusion of type III dialy- sate solution (DIAL) with the same pressure; no change in intra-abdominal pressure (CTRL). All groups received intravenous resuscitation when their mean arterial pressure was below 30 mmHg. Physio- logic parameters were recorded during 20 min of bleeding. Results. Red blood cell (RBC) volume loss in the DIAL and GAS was 45% and 48% lower than that in the CTRL, respectively (P < 0.0005). Similar trends were observed for losses in RBC count and hemoglobin (Hb). Final mean arterial pressure, arterial RBC, Hb, and hematocrit were higher in the DIAL and GAS than in the CTRL; glucose concentration in the DIAL group was significantly higher than that in the GAS and CTRL groups. No intravenous fluid therapy was needed in the DIAL group. Conclusions. Hyperpressure intraperitoneal dialy- sate administration successfully reduced bleeding after severe liver injury in rabbits. This method can potentially be used as an adjunct to increase patient survival during pre-hospital cares. Ó 2012 Elsevier Inc. All rights reserved. Key Words: peritoneal dialysis; hepatic trauma; hem- orrhage; increased intra-abdominal pressure; preho- spital care. INTRODUCTION Acute hemorrhage is the main cause of death in trauma patients [1], with the first minutes after trauma determining the fate of patients; 66.5% of trauma deaths occur less than 1 h after injury [2]. The liver is the most commonly injured organ in abdominal cavity trauma [3]. Because of the vascular nature of the liver, injury to this organ can easily lead to catastrophic bleeding and death. After more than 2000 years, there have been very few changes in the pre-hospital care of hemorrhagic injuries [4], and many victims of trau- matic bleeding lose their lives because of improper hem- orrhage control during the pre-hospital transport. A traumatized intra-abdominal organ may continually bleed as the patient is transported from the accident site to the operating room. Ideally, the treatment of choice for hemorrhagic shock is to find and block the source of bleeding as soon as possible, but during trans- port, only the maintenance of ventilation and adminis- tration of intravenous (i.v.) fluid are used to prevent shock. With the current methods of pre-hospital care for hemorrhaging patients, 30%–40% of all civilian deaths due to massive hemorrhage and 90% of all military deaths due to massive hemorrhage occur in pre-hospital transport prior to the patient reaching definitive medical care [4]. 1 To whom correspondence and reprint requests should be ad- dressed at Department of Clinical Sciences, Faculty of Veterinary Med- icine, Urmia University, Urmia, 57155-1177, Iran. E-mail: s.azizi@ urmia.ac.ir. 0022-4804/$36.00 Ó 2012 Elsevier Inc. All rights reserved. 559 Journal of Surgical Research 176, 559–566 (2012) doi:10.1016/j.jss.2011.10.002