Fluid resuscitation following liver laceration: A comparison of fluid delivery above and below the diaphragm in a pediatric animal model

Liver laceration is the most common cause of mortality following blunt abdominal trauma in children. To determine the optimal route for volume expansion in the clinical setting of blunt abdominal injury, we compared the response to fluid resuscitation delivered above (Group 1) or below (Group 2) the diaphragm in a canine model of liver laceration. After induction of hemorrhagic shock by resection of 45% to 55% of the right median hepatic lobe followed by immediate closure of the laparotomy incision, we monitored pulse, arterial and venous pressures, urine output, pH, and lactate levels for three hours or until death. Physiologic and biochemical parameters did not differ significantly between the two groups; three of six (50%) of those receiving fluids through the external jugular vein and four of seven (57%) resuscitated through the femoral vein survived for three hours. Comparing survivors and nonsurvivors in both groups, those animals that lived for three hours maintained a higher pH, a greater urine output, and a lower serum lactate level. We conclude that the route of IV fluid administration does not affect the response to volume expansion; lactate levels, urine output, and pH provide valuable guides to the adequacy of resuscitation; and in appropriately resuscitated patients, even with serious liver lacerations, operative repair may be unnecessary except in the face of clinical or biochemical deterioration despite optimal fluid and blood replacement.