Document Detail


Hemoglobin-based oxygen carrier provides heterogeneous microvascular oxygenation in heart and gut after hemorrhage in pigs.
MedLine Citation:
PMID:  14676658     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: In this study, the hypothesis was tested that resuscitation with hemoglobin-based oxygen carriers (HBOCs) affects the oxygenation of the microcirculation differently between and within organs. To this end, we tested the influence of the volume of an HBOC on the microcirculatory oxygenation of the heart and the gut serosa and mucosa in a porcine model of hemorrhage. METHODS: In anesthetized open-chested pigs (n = 24), a controlled hemorrhage (30 mL/kg over 1 hour) was followed by resuscitation with 10, 20, or 30 mL/kg diaspirin-crosslinked hemoglobin (DCLHb) or isovolemic resuscitation with 30 mL/kg of a 6% hydroxyethyl starch solution (HAES). Measurements included systemic and regional hemodynamic and oxygenation parameters. Microvascular oxygen pressures (microPO2) of the epicardium and the serosa and mucosa of the ileum were measured simultaneously by the palladium-porphyrin phosphorescence technique. Measurements were obtained up to 120 minutes after resuscitation. RESULTS: After hemorrhage, a low volume of DCLHb restored both cardiac and intestinal microPO2. Resuscitation of gut microPO2 with a low volume of DCLHb was as effective as isovolemic resuscitation with HAES. Higher volumes of DCLHb did not restore cardiac microPO2, as did isovolemic resuscitation with HAES, but increased gut microPO2 to hyperoxic values, dose-dependently. Effects were similar for the serosal and mucosal microPo2. In contrast to a sustained hypertensive effect after resuscitation with DCLHb, effects of DCLHb on regional oxygenation and hemodynamics were transient. CONCLUSION: This study showed that a low volume of DCLHb was effective in resuscitation of the microcirculatory oxygenation of the heart and gut back to control levels. Increasing the volume of DCLHb did not cause an additional increase in heart microPO2, but caused hyperoxic microvascular values in the gut to be attained. It is concluded that microcirculatory monitoring in this way elucidates the regional behavior of oxygen transport to the tissue by HBOCs, whereas systemic variables were ineffective in describing their response.
Authors:
Mat van Iterson; Martin Siegemund; Kenneth Burhop; Can Ince
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Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  The Journal of trauma     Volume:  55     ISSN:  0022-5282     ISO Abbreviation:  J Trauma     Publication Date:  2003 Dec 
Date Detail:
Created Date:  2003-12-16     Completed Date:  2004-01-12     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  0376373     Medline TA:  J Trauma     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1111-24     Citation Subset:  AIM; IM    
Affiliation:
Department of Physiology, Academic Medical Center, University of Amsterdam, The Netherlands.
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MeSH Terms
Descriptor/Qualifier:
Analysis of Variance
Animals
Aspirin / analogs & derivatives*,  pharmacology,  therapeutic use*
Disease Models, Animal*
Dose-Response Relationship, Drug
Drug Evaluation, Preclinical
Drug Monitoring
Female
Fluid Therapy / methods
Hemoglobins / pharmacology,  therapeutic use*
Hetastarch / administration & dosage*,  pharmacology
Ileum / blood supply,  chemistry,  drug effects,  metabolism
Intestinal Mucosa / blood supply,  chemistry,  drug effects,  metabolism*
Microcirculation / drug effects*
Oxygen / analysis,  metabolism
Oxygen Consumption / drug effects
Pericardium / chemistry,  drug effects,  metabolism*
Plasma Substitutes / administration & dosage*,  pharmacology
Resuscitation / methods
Shock, Hemorrhagic / drug therapy*,  metabolism,  physiopathology
Swine
Time Factors
Chemical
Reg. No./Substance:
0/Hemoglobins; 0/Plasma Substitutes; 0/diaspirin-cross-linked hemoglobin; 50-78-2/Aspirin; 7782-44-7/Oxygen; 9005-27-0/Hetastarch

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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