Document Detail

Regional and local brain oxygenation during hemorrhagic shock: a prospective experimental study on the effects of small-volume resuscitation with norepinephrine.
MedLine Citation:
PMID:  18332803     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Patients with uncontrolled hemorrhage may benefit if resuscitation with large amounts of fluids is replaced by a small volume or vasopressor until surgery. Norepinephrine (NE) is commonly used as a vasopressor to control hypotension. The purpose of this study was to compare the effects of hypertonic-hyperoncotic saline starch solution (HHS) either alone or combined with NE on brain tissue oxygen pressure (PbtO2) and brain oxygen saturation (rSO2) in a model of uncontrolled hemorrhage. METHODS: After approval of the animal investigation committee, 22 anesthetized pigs underwent simulated penetrating liver trauma. At hemodynamic decompensation, animals were randomly assigned to receive HHS (Hyperhaes; 4 mL/kg; n = 8) with normal saline placebo, low-dose NE (low NE; 500 microg, and 1 microg/kg/min; n = 7), or high-dose NE (high NE; 1,000 microg, and 1 microg/kg/min; n = 7). Bleeding was controlled manually 30 minutes after drug administration. RESULTS: Cerebral perfusion pressure (CePP), PbtO2, and rSO2 decreased with hemorrhage in all groups (baseline vs. decompensation, CePP-HHS, 83 +/- 5 mm Hg vs. 9 +/- 1 mm Hg; low NE, 67 +/- 6 mm Hg vs. 16 +/- 2 mm Hg; high NE, 77 +/- 7 mm Hg vs. 15 +/- 1 mm Hg. PbtO2-HHS, 100% vs. 29%; low NE, 100% vs. 33%; high NE, 100% vs. 27%. rSO2-HHS, 100% vs. 70%; low NE, 100% vs. 76%; high NE, 100% vs. 63%). Therapy with HHS, low NE, and high NE resulted in a comparable increase of CePP, PbtO2, and rSO2, respectively (5 minutes after therapy, CePP-HHS, 29 +/- 3 mm Hg; low NE, 27 +/- 3 mm Hg; high NE, 28 +/- 3 mm Hg. PbtO2-HHS, 207%; low NE, 129%; high NE, 170%. rSO2-HHS, 94%; low NE, 83%; high NE, 87%). Overall survival was six of eight, four of seven, and six of seven, respectively. CONCLUSION: After uncontrolled hemorrhagic shock, addition of different dosages of NE to HHS, compared with HHS alone, showed no beneficial effect on CePP, rSO2, or PbtO2.
Erol Cavus; Patrick Meybohm; Volker Dörges; Karl-Heinz Stadlbauer; Volker Wenzel; Heiko Weiss; Jens Scholz; Berthold Bein
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Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  The Journal of trauma     Volume:  64     ISSN:  1529-8809     ISO Abbreviation:  J Trauma     Publication Date:  2008 Mar 
Date Detail:
Created Date:  2008-03-11     Completed Date:  2008-04-10     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0376373     Medline TA:  J Trauma     Country:  United States    
Other Details:
Languages:  eng     Pagination:  641-8; discussion 648-9     Citation Subset:  AIM; IM    
Department of Anaesthesiology and Intensive Care Medicine, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany.
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MeSH Terms
Analysis of Variance
Blood Gas Analysis
Brain / metabolism*
Cerebrovascular Circulation / drug effects
Hetastarch / pharmacology*
Liver / injuries
Norepinephrine / pharmacology*
Oxygen / metabolism*
Plasma Substitutes / pharmacology*
Prospective Studies
Resuscitation / methods*
Shock, Hemorrhagic / drug therapy*,  metabolism
Statistics, Nonparametric
Survival Rate
Reg. No./Substance:
0/Plasma Substitutes; 51-41-2/Norepinephrine; 7782-44-7/Oxygen; 9005-27-0/Hetastarch

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