Document Detail


Oxygen debt criteria quantify the effectiveness of early partial resuscitation after hypovolemic hemorrhagic shock.
MedLine Citation:
PMID:  12777899     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: The effectiveness of partial resuscitation after hypovolemic hemorrhagic shock with deferment of full resuscitation is critical to successful hypotensive resuscitation. METHODS: To quantitatively address this issue, 40 canines were bled under anesthesia to a mean oxygen debt (O(2)D) of 104 +/- 7.6 mL/kg over 60 minutes (mortality, 40%). Animals surviving the shock were then immediately resuscitated with 0%, 8.4%, 15%, 30%, or 120% (full resuscitation) of shed volume as 5% albumin and held for 2 hours postshock, when the remaining portion of full resuscitation volume was given. Animals were followed for 7 days postshock with hepatic and renal function studies, and then, under anesthesia, cardiac output and organ biopsy specimens were taken before the animals were killed. RESULTS: By 2 hours postshock, 0% immediate resuscitation had an O(2)D increase of 80 mL/kg above end of shock, but O(2)D at 8.4% immediate resuscitation decreased -30 mL/kg, 15% immediate resuscitation fell -65 mL/kg, 30% immediate resuscitation decreased -80 mL/kg below end of shock, and O(2)D with 120% full resuscitation fell to preshock levels. All decreases in O(2)D were significantly (p < 0.05) below end of shock, but both 15% and 30% immediate resuscitation exceeded the 8.4% immediate resuscitation rate (p < 0.05) throughout the resuscitation, and 120% full resuscitation exceeded these (p < 0.05). The immediate resuscitation O(2)D response correlated significantly (p < 0.001) with base deficit and lactate, but blood pressure was not a significant discriminator. Seven-day biopsies showed return of bowel mucosa but a pattern of cellular injury in heart, liver, and kidney that improved from 8.4% < 15% < 30 < 120% immediate resuscitation. CONCLUSION: The data suggest that, compared with 120% postshock immediate resuscitation, 8.4% and 15% immediate resuscitation give poorer results, with 30% immediate resuscitation showing mild, transient, but acceptable changes in organ function allowing for a 2-hour delay until full resuscitation, with complete 7-day recovery. Base deficit and lactate, but not blood pressure, are significant indices of O(2)D.
Authors:
John H Siegel; Miklos Fabian; Joyce A Smith; Ella P Kingston; Kristie A Steele; Michelle R Wells; Lewis J Kaplan
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  The Journal of trauma     Volume:  54     ISSN:  0022-5282     ISO Abbreviation:  J Trauma     Publication Date:  2003 May 
Date Detail:
Created Date:  2003-06-02     Completed Date:  2003-06-19     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  0376373     Medline TA:  J Trauma     Country:  United States    
Other Details:
Languages:  eng     Pagination:  862-80; discussion 880     Citation Subset:  AIM; IM    
Affiliation:
Department of Surgery, New Jersey Medical School, University of Medicine and Dentistry of New Jersey, Newark, 07101-1709, USA. siegeljh@umdnj.edu
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MeSH Terms
Descriptor/Qualifier:
Albumins / therapeutic use
Animals
Blood Volume
Carbon Monoxide / metabolism
Disease Models, Animal
Dogs
Fluid Therapy
Kidney / pathology
Liver / pathology
Male
Oxygen / blood
Oxygen Consumption*
Resuscitation / methods*
Shock, Hemorrhagic / metabolism,  pathology,  therapy*
Chemical
Reg. No./Substance:
0/Albumins; 630-08-0/Carbon Monoxide; 7782-44-7/Oxygen

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


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