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Impact of Immunopathy and Coagulopathy on Multi-Organ Failure and Mortality in a Lethal Porcine Model of Controlled and Uncontrolled Hemorrhage.
Simovic, Milomir O; Bynum, James; Liu, Bin; Dalle Lucca, Jurandir J; Li, Yansong.
Afiliação
  • Simovic MO; US Army Institute of Surgical Research, Fort Sam Houston, TX 78234, USA.
  • Bynum J; The Geneva Foundation, Tacoma, WA 98402, USA.
  • Liu B; Department of Surgery, University of Texas Health Science Center at San Antonio, San Antonio, TX 78229, USA.
  • Dalle Lucca JJ; US Army Institute of Surgical Research, Fort Sam Houston, TX 78234, USA.
  • Li Y; Department of Surgery, University of Texas Health Science Center at San Antonio, San Antonio, TX 78229, USA.
Int J Mol Sci ; 25(5)2024 Feb 21.
Article em En | MEDLINE | ID: mdl-38473750
ABSTRACT
Uncontrolled hemorrhage is a major preventable cause of death in patients with trauma. However, the majority of large animal models of hemorrhage have utilized controlled hemorrhage rather than uncontrolled hemorrhage to investigate the impact of immunopathy and coagulopathy on multi-organ failure (MOF) and mortality. This study evaluates these alterations in a severe porcine controlled and uncontrolled hemorrhagic shock (HS) model. Anesthetized female swine underwent controlled hemorrhage and uncontrolled hemorrhage by partial splenic resection followed with or without lactated Ringer solution (LR) or Voluven® resuscitation. Swine were surveyed 6 h after completion of splenic hemorrhage or until death. Blood chemistry, physiologic variables, systemic and tissue levels of complement proteins and cytokines, coagulation parameters, organ function, and damage were recorded and assessed. HS resulted in systemic and local complement activation, cytokine release, hypocoagulopathy, metabolic acidosis, MOF, and no animal survival. Resuscitation with LR and Voluven® after HS improved hemodynamic parameters (MAP and SI), metabolic acidosis, hyperkalemia, and survival but resulted in increased complement activation and worse coagulopathy. Compared with the LR group, the animals with hemorrhagic shock treated with Voluven® had worse dilutional anemia, coagulopathy, renal and hepatic dysfunction, increased myocardial complement activation and renal damage, and decreased survival rate. Hemorrhagic shock triggers early immunopathy and coagulopathy and appears associated with MOF and death. This study indicates that immunopathy and coagulopathy are therapeutic targets that may be addressed with a high-impact adjunctive treatment to conventional resuscitation.
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Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Choque Hemorrágico / Acidose / Transtornos da Coagulação Sanguínea Limite: Animals / Female / Humans Idioma: En Ano de publicação: 2024 Tipo de documento: Article

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Choque Hemorrágico / Acidose / Transtornos da Coagulação Sanguínea Limite: Animals / Female / Humans Idioma: En Ano de publicação: 2024 Tipo de documento: Article