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An Ovine Model of Hemorrhagic Shock and Resuscitation, to Assess Recovery of Tissue Oxygen Delivery and Oxygen Debt, and Inform Patient Blood Management.
Dyer, Wayne B; Tung, John-Paul; Li Bassi, Gianluigi; Wildi, Karin; Jung, Jae-Seung; Colombo, Sebastiano Maria; Rozencwajg, Sacha; Simonova, Gabriela; Chiaretti, Sara; Temple, Fergal T; Ainola, Carmen; Shuker, Tristan; Palmieri, Chiara; Shander, Aryeh; Suen, Jacky Y; Irving, David O; Fraser, John F.
Afiliação
  • Dyer WB; Australian Red Cross Lifeblood, Sydney, Australia.
  • Tung JP; Faculty of Medicine and Health, University of Sydney, Sydney, Australia.
  • Li Bassi G; Australian Red Cross Lifeblood, Brisbane, Australia.
  • Wildi K; Critical Care Research Group, The Prince Charles Hospital, Brisbane, Australia.
  • Jung JS; Faculty of Medicine, The University of Queensland, Brisbane, Australia.
  • Colombo SM; Faculty of Health, Queensland University of Technology, Brisbane, Australia.
  • Rozencwajg S; Critical Care Research Group, The Prince Charles Hospital, Brisbane, Australia.
  • Simonova G; Faculty of Medicine, The University of Queensland, Brisbane, Australia.
  • Chiaretti S; Medical Engineering Research Facility, Queensland University of Technology, Brisbane, Australia.
  • Temple FT; Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain.
  • Ainola C; Critical Care Research Group, The Prince Charles Hospital, Brisbane, Australia.
  • Shuker T; Faculty of Medicine, The University of Queensland, Brisbane, Australia.
  • Palmieri C; Cardiovascular Research Institute, Basel, Switzerland.
  • Shander A; Critical Care Research Group, The Prince Charles Hospital, Brisbane, Australia.
  • Suen JY; Department of Thoracic and Cardiovascular Surgery, College of Medicine, Korea University, Seoul, Republic of Korea.
  • Irving DO; Critical Care Research Group, The Prince Charles Hospital, Brisbane, Australia.
  • Fraser JF; Faculty of Medicine, The University of Queensland, Brisbane, Australia.
Shock ; 56(6): 1080-1091, 2021 12 01.
Article em En | MEDLINE | ID: mdl-34014886
BACKGROUND: Aggressive fluid or blood component transfusion for severe hemorrhagic shock may restore macrocirculatory parameters, but not always improve microcirculatory perfusion and tissue oxygen delivery. We established an ovine model of hemorrhagic shock to systematically assess tissue oxygen delivery and repayment of oxygen debt; appropriate outcomes to guide Patient Blood Management. METHODS: Female Dorset-cross sheep were anesthetized, intubated, and subjected to comprehensive macrohemodynamic, regional tissue oxygen saturation (StO2), sublingual capillary imaging, and arterial lactate monitoring confirmed by invasive organ-specific microvascular perfusion, oxygen pressure, and lactate/pyruvate levels in brain, kidney, liver, and skeletal muscle. Shock was induced by stepwise withdrawal of venous blood until MAP was 30 mm Hg, mixed venous oxygen saturation (SvO2) < 60%, and arterial lactate >4 mM. Resuscitation with PlasmaLyte® was dosed to achieve MAP > 65 mm Hg. RESULTS: Hemorrhage impacted primary outcomes between baseline and development of shock: MAP 89 ±â€Š5 to 31 ±â€Š5 mm Hg (P < 0.01), SvO2 70 ±â€Š7 to 23 ±â€Š8% (P < 0.05), cerebral regional tissue StO2 77 ±â€Š11 to 65 ±â€Š9% (P < 0.01), peripheral muscle StO2 66 ±â€Š8 to 16 ±â€Š9% (P < 0.01), arterial lactate 1.5 ±â€Š1.0 to 5.1 ±â€Š0.8 mM (P < 0.01), and base excess 1.1 ±â€Š2.2 to -3.6 ±â€Š1.7 mM (P < 0.05). Invasive organ-specific monitoring confirmed reduced tissue oxygen delivery; oxygen tension decreased and lactate increased in all tissues, but moderately in brain. Blood volume replacement with PlasmaLyte® improved primary outcome measures toward baseline, confirmed by organ-specific measures, despite hemoglobin reduced from baseline 10.8 ±â€Š1.2 to 5.9 ±â€Š1.1 g/dL post-resuscitation (P < 0.01). CONCLUSION: Non-invasive measures of tissue oxygen delivery and oxygen debt repayment are suitable outcomes to inform Patient Blood Management of hemorrhagic shock, translatable for pre-clinical assessment of novel resuscitation strategies.
Assuntos

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Oxigênio / Consumo de Oxigênio / Ressuscitação / Choque Hemorrágico / Recuperação de Função Fisiológica Limite: Animals / Female / Humans / Middle aged Idioma: En Revista: Shock Ano de publicação: 2021 Tipo de documento: Article

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Oxigênio / Consumo de Oxigênio / Ressuscitação / Choque Hemorrágico / Recuperação de Função Fisiológica Limite: Animals / Female / Humans / Middle aged Idioma: En Revista: Shock Ano de publicação: 2021 Tipo de documento: Article