Post-occlusive reactive hyperemia variables can be used to diagnose vascular dysfunction in hemorrhagic shock.

INTRODUCTION: Laser doppler flowmetry (LDF) allows non-invasive assessment of microvascular functions. The combination of LDF with an occlusion functional test enables study of post-occlusive reactive hyperemia (PORH), providing additional information about vasomotor function, capillary blood flow reserve, and the overall reactivity of the microvascular system. AIM: To identify early alterations of PORH variables in the skin of a rat in hemorrhagic shock (HS). MATERIAL AND METHODS: Male Wistar rats (n = 14) weighing 400-450 g were anesthetized with a combination of tiletamine/zolazepam (20 mg/kg) and xylazine (5 mg/kg). The animals breathed on their own, and were placed on a heated platform in the supine position. A PE-50 catheter was inserted into the carotid artery to measure the mean arterial pressure (MAP). The optical probe of the Laser Doppler device was installed on the plantar surface of the hind limb of a rat; a pneumatic cuff was applied proximal to the same limb. The occlusion time was 3 min. The following physiological variables were measured at baseline and 30 min after blood loss: MAP, mmHg; mean cutaneous blood flow (M, PU); cutaneous vascular conductance (CVC = M/MAP); peak hyperemia (Mmax, PU) and maximum cutaneous vascular conductance (CVCmax) during PORH. In the HS group (n = 7), 30 % of the estimated blood volume was taken within 5 min. There was no blood loss in the group of sham-operated animals (Sham, n = 7). The results are presented as Me [25 %;75 %]. The U-Mann-Whitney criterion was used to evaluate intergroup differences. Differences were considered statistically significant at p < 0.05. RESULTS: The groups did not differ at baseline. Blood loss led to a significant decrease in MAP (43 [31;46] vs. 94 [84;104] mmHg), M (11.5 [16.9;7.8] vs 16.7 [20.2;13.9]) and Mmax (18.1 [16.4;21.8] vs. 25.0 [23.0;26.2]) in the HS group compared to the Sham group, respectively. At the same time, both CVC (0.25 [0.23;0.30] vs. 0.16 [0.14;0.21]) and CVCmax (0.55 [0.38;0.49] vs 0.24 [0.23; 0.29]) increased after blood loss in the HS group compared to the Sham group. Arterial blood gas analysis revealed metabolic lactic acidosis in the HS group. CONCLUSION: In this rat model of HS, alterations in cutaneous blood flow are manifested by a decrease in perfusion (M) and the intensity of PORH (Mmax) with a simultaneous increase in vascular conductance (CVC and CVCmax).

Novel combined strategy of obstetric haemorrhage management during caesarean section using intrauterine balloon tamponade.

OBJECTIVE: The aim of this trial was to evaluate the performance of a combined strategy of postpartum haemorrhage management, based upon thromboelastographic (TEG) assessment of coagulation, early surgical haemostasis and mechanical compression of the uterine wall combined with uterine cavity draining, via intrauterine balloon tamponade (BT). METHODS: We carried out an open controlled trial, which included 119 women with obstetric haemorrhage (main group - combined strategy: n = 90, control group - conventional strategy: n = 29). The combined strategy included three essential components: (1) early surgical haemostasis, (2) mechanical pressure upon the uterine wall and draining of the uterine cavity via BT and (3) treatment of blood coagulation disorders identified via TEG. RESULTS: The combined haemorrhage management strategy resulted in significantly lower number of peripartum hysterectomies compared with standard management (4.44% versus 31.03%, respectively, p = 0.02). Blood loss of >2000 ml occurred significantly less common in the main group compared with the control group (16.2% versus 27.6%, respectively, p = 0.03). Mean total blood loss after combined management was significantly lower than after the standard approach (2502 ± 203 ml versus 1836 ± 108 ml, p = 0.04). CONCLUSIONS: The proposed combined strategy of obstetric haemorrhage management represents a powerful tool for fertility-sparing treatment of this life-threatening condition.

Sleep-disordered breathing in 15-year-old boy with arterial hypertension.

Obstructive sleep apnea/hypopnea syndrome (OSA/HS) is the basis of the spectrum of sleep-disordered breathing (SDB) and is a condition characterized by the presence of snoring, repetitive partial upper airway obstruction (hypopnea) and/or intermittent complete obstruction (apnea), long enough to cause reduce the level of oxygen in the blood (desaturation), fragmented sleep and excessive daytime sleepiness. It is known that OSA/HS in the middle and older age predisposes to arterial hypertension (AH). We discuss a case of 15-year-old boy with AH and OSA/HS. He was treated on nasal continuous positive pressure in the upper airway (nasal CPAP) with good results.