| Vasoactivity of bovine polymerized hemoglobin (HBOC-201) in swine with traumatic hemorrhagic shock with and without brain injury. | |
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MedLine Citation:
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PMID: 17099513 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: We previously reported that bovine polymerized hemoglobin (HBOC- 201) improved outcome in swine with hemorrhagic shock (HS) with and without traumatic brain injury (TBI). Herein, we add analyses of blood pressure (BP) responses, associated physiologic data, and HS fluid infusion guidelines. METHODS: HBOC-201 versus standard fluid resuscitation was compared in four anesthetized invasively monitored swine models: moderate controlled HS, severe controlled HS, severe uncontrolled HS (liver injury), and severe uncontrolled HS/TBI (liver/parietal brain injuries). Pigs received fluid for hypotension and tachycardia, and were followed up to 6 (HS alone) or 72 hours (HS/TBI). The change in mean arterial pressure (DeltaMAP) response severity was stratified and analyzed based on infusion number and HS severity, using Student's t and Fisher's exact tests. RESULTS: HBOC-201 vasoactivity resulted in higher MAP in all studies. Among HBOC-201 pigs, DeltaMAP responses were significant for the first two infusions and inversely related to HS severity. Among controls, DeltaMAP responses remained significant through the fourth infusion in controlled HS models, and through the first in severe uncontrolled HS/TBI; none were significant in severe uncontrolled HS. DeltaMAP was higher with HBOC-201 through the first infusion in moderate controlled HS, the fifth in severe uncontrolled HS, and the second in severe uncontrolled HS/TBI; there were no group differences in severe controlled HS. No severe MAP responses occurred. Higher DeltaMAP severity did not impact outcome. Hypotension satisfied fluid reinfusion criteria less consistently than tachycardia. Overall, HBOC-201 improved physiologic parameters and survival without causing hypoperfusion; in severe HS, perfusion improved. CONCLUSIONS: In swine with HS +/- TBI, HBOC-201 had mild to moderate vasoactivity, resulting in significant DeltaMAP responses mainly after initial infusions, no severe/adverse responses, and improved outcome. Our data suggest that use of physiologic parameters (e.g., tachycardia), in addition to hypotension to guide fluid reinfusion during HS resuscitation with HBOC-201, will minimize hypoperfusion risk and maximize potential benefit. |
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Authors:
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Jennifer Rice; Nora Philbin; Michael Handrigan; Carrie Hall; Gerald McGwin; Stephen Ahlers; L B Pearce; Francoise Arnaud; Richard McCarron; Daniel Freilich |
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Publication Detail:
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Type: Comparative Study; Journal Article; Research Support, U.S. Gov't, Non-P.H.S. |
Journal Detail:
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Title: The Journal of trauma Volume: 61 ISSN: 0022-5282 ISO Abbreviation: J Trauma Publication Date: 2006 Nov |
Date Detail:
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Created Date: 2006-11-13 Completed Date: 2006-12-22 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 0376373 Medline TA: J Trauma Country: United States |
Other Details:
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Languages: eng Pagination: 1085-99 Citation Subset: AIM; IM |
Affiliation:
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Combat Casualty Directorate, Naval Medical Research Center, Silver Spring, Maryland 20910-7500, USA. |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Animals Blood Pressure / drug effects* Blood Substitutes / pharmacology, therapeutic use* Brain Injuries / complications Disease Models, Animal Drug Evaluation, Preclinical Fluid Therapy Heart Rate / drug effects Hemoglobins / pharmacology, therapeutic use* Hypotension / drug therapy Infusions, Intravenous Isotonic Solutions / therapeutic use Resuscitation / methods* Shock, Hemorrhagic / drug therapy*, etiology, mortality, physiopathology Swine Tachycardia / drug therapy |
| Chemical | |
Reg. No./Substance:
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0/Blood Substitutes; 0/HBOC 201; 0/Hemoglobins; 0/Isotonic Solutions; 8022-63-7/Ringer's lactate |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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