Document Detail


Severe Traumatic Brain Injury and Controlled Hemorrhage in Rats: Quest for the Optimal Mean Arterial Blood Pressure After Whole Fresh Donor Blood Resuscitation.
MedLine Citation:
PMID:  23143053     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
ABSTRACT: Treatment of combined traumatic brain injury and hypovolemic shock, poses a particular challenge due to the possible conflicting consequences. While restoring diminished volume is the treatment goal for hypovolemia, maintaining and adequate cerebral perfusion pressure and avoidance of secondary damage remains a treatment goal for the injured brain. Various treatment modalities have been proposed, but the optimal resuscitation fluid and goals have not yet been clearly defined. In this study we investigate the physiological and neurological outcomes in a rat model of combined TBI and hypovolemic shock, submitted to treatment with varying amounts of fresh blood. MATERIALS AND METHODS: 48 Male Lewis rats were divided into control and treatment groups. TBI was inflicted by a free falling rod on the exposed cranium. Hypovolemia was induced by controlled hemorrhage of 30% blood volume. Treatment groups were treated by fresh whole blood with varying volumes, reaching resuscitation goals of a mean arterial blood pressure (MAP) of 80, 100, 120 mmHg at 15 minutes. MAP was assessed at 60 minutes, and neurological outcomes and mortality in the subsequent 48 hours. RESULTS: At 60 minutes MAP was highest for the group resuscitated most aggressively. Neurological outcomes and mortality inversely correlated with the aggressiveness of resuscitation. CONCLUSIONS: In this study we find that mild resuscitation with goals of restoring MAP to 80 mmHg (which is lower than baseline) provided best results when considering hemodynamic stability, survival and neurological outcomes. An aggressive resuscitation may be detrimental inducing processes which eventually cause a significant decrease in survival.
Authors:
Evgeni Brotfain; Akiva Leibowitz; Dalit E Dar; Michael M Krausz; Yoram Shapira; Leonid Koyfman; Moti Klein; Shmuel Hess; Alexander Zlotnik
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-11-8
Journal Detail:
Title:  Shock (Augusta, Ga.)     Volume:  -     ISSN:  1540-0514     ISO Abbreviation:  Shock     Publication Date:  2012 Nov 
Date Detail:
Created Date:  2012-11-12     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9421564     Medline TA:  Shock     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Affiliation:
1Department of Anesthesiology and Critical Care, Soroka Medical Center, Ben-Gurion University of the Negev, Faculty of health science, Beer Sheva, Israel. 2Laboratory for Shock and Trauma Research and Department of Surgery A, Rambam Medical Center, and the Technion-Israel Institute of Technology, POB 9602, Haifa 31096, Israel. 3Hillel Yaffe Medical Center, Hadera, Israel #Equal contribution.
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