Document Detail

Improving microcirculation is more effective than substitution of red blood cells to correct metabolic disorder in experimental hemorrhagic shock.
MedLine Citation:
PMID:  14770036     Owner:  NLM     Status:  MEDLINE    
Microcirculatory perfusion deficits and impaired tissue oxygenation in nonvital organs frequently occur after hemorrhage and they contribute to potentially lethal complications. The aim of this study was to test the influence of colloid osmotic pressure, viscosity, and red blood cell (RBC) content of the resuscitative fluid on metabolic disorder, perfusion, and oxygenation in peripheral tissues. Awake hamsters were subjected to hemorrhage of 50% and were resuscitated with 25% of blood volume with solutions containing 6% pegylated bovine albumin only (PEG-BSA 0) and 6% PEG-BSA mixed with autologous RBCs to reach 4 g/dL (PEG-BSA 4) and 8 g/dL (PEG-BSA 8) of hemoglobin. PEG-BSA had a viscosity of 4.2 cP and a COP of 116 mmHg. Microhemodynamics and tissue pO2 were assessed in the hamster chamber window preparation with intravital microscopy. Arterial base excess tended to be lower than baseline for PEG-BSA 0 and PEG-BSA 4 (ns), whereas base deficit remained significantly decreased for PEG-BSA 8 (P<0.05 vs. baseline). Oxygen extraction was 91% +/- 2% of the oxygen delivery for PEG-BSA 0 compared with 85% +/- 2% for PEG-BSA 8 (P<0.05). Functional capillary density was 61%, 47%, and 45% for PEG-BSA 0 (P<0.05 vs. other groups), PEG-BSA 4 and PEG-BSA 8, respectively. We conclude that arterial base excess and oxygen extraction ratio in the tissue was better restored if a higher fraction of PEG-BSA and less RBCs were infused. This was attributed to a more homogeneous distribution of oxygen, as reflected by functional capillary density. Our results suggest that the transfusion trigger in hemorrhagic shock may be shifted toward lower hemoglobin concentrations if highly viscous and oncotic solutions are used.
Reto Wettstein; Amy G Tsai; Dominique Erni; Anatoly N Lukyanov; Vladimir P Torchilin; Marcos Intaglietta
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Publication Detail:
Type:  Journal Article; Research Support, U.S. Gov't, P.H.S.    
Journal Detail:
Title:  Shock (Augusta, Ga.)     Volume:  21     ISSN:  1073-2322     ISO Abbreviation:  Shock     Publication Date:  2004 Mar 
Date Detail:
Created Date:  2004-02-10     Completed Date:  2004-10-19     Revised Date:  2007-11-14    
Medline Journal Info:
Nlm Unique ID:  9421564     Medline TA:  Shock     Country:  United States    
Other Details:
Languages:  eng     Pagination:  235-40     Citation Subset:  IM    
Department of Bioengineering, University of California, San Diego, La Jolla, California 92093, USA.
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MeSH Terms
Arteries / pathology
Capillaries / metabolism
Carotid Arteries / pathology
Colloids / metabolism
Erythrocytes / metabolism*
Hemoglobins / chemistry,  metabolism
Hydrogen-Ion Concentration
Osmotic Pressure
Oxygen / metabolism
Oxygen Consumption
Partial Pressure
Polyethylene Glycols / chemistry
Serum Albumin, Bovine / metabolism
Shock, Hemorrhagic / pathology*
Time Factors
Grant Support
Reg. No./Substance:
0/Colloids; 0/Hemoglobins; 0/Polyethylene Glycols; 0/Serum Albumin, Bovine; 7782-44-7/Oxygen

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