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Effects of low-volume hemoglobin glutamer-200 versus normal saline and arginine vasopressin resuscitation on systemic and skeletal muscle blood flow and oxygenation in a canine hemorrhagic shock model.
Crit Care Med. 2007 Sep; 35(9):2101-9.CC

Abstract

OBJECTIVE

To test the hypothesis that low-volume resuscitation with hemoglobin glutamer-200 improves hemodynamic function and tissue oxygenation, whereas arginine vasopressin resuscitation improves blood pressures more than low-volume saline or hemoglobin glutamer infusion but compromises systemic and muscle blood flow and oxygenation.

DESIGN

Randomized laboratory investigation.

SETTING

University research facility.

SUBJECTS

Nineteen dogs.

INTERVENTIONS

Dogs were instrumented to determine heart rate; arterial, central venous, pulmonary arterial, and pulmonary arterial occlusion pressures; cardiac output; and quadriceps muscle blood flow and oxygen tension (PMo2). Total and plasma hemoglobin, oxygen content, lactate, pH, standard base excess, and arginine vasopressin levels were determined, and systemic oxygen delivery (Do2I) and extraction ratio were calculated. Measurements were made before and 30 mins following hemorrhage. Dogs were resuscitated over 60 mins with saline (8.5 mL/kg), arginine vasopressin (0.4 IU/kg bolus plus 0.08 IU x kg x min), or 1:1 diluted hemoglobin glutamer-200. Recordings were then repeated. Subsequently, animals received 30 mL/kg shed blood (60 mL x kg x hr), and recordings were repeated immediately and 1 hr later.

MEASUREMENTS AND MAIN RESULTS

Hemorrhage (approximately 52 mL/kg) caused characteristic changes in hemodynamic, hematologic, systemic PMo2, and acid-base variables. Saline resuscitation increased both Do2I and muscle perfusion by 42% and 51%, while arginine vasopressin treatment reduced heart rate by 31% and increased mean arterial pressure by 22% but not cardiac output, Do2I, or muscle blood flow, resulting in a further decrease of PMo2 by 68% and worse metabolic acidosis. Hemoglobin glutamer-200 infusion caused systemic and pulmonary vasoconstriction, however, without deterioration of cardiac output, Do2I, muscle blood flow, or PMo2 despite lack of oxygen content increase. Blood transfusion restored most variables.

CONCLUSIONS

Low-volume crystalloid or hemoglobin glutamer-200 resuscitation posthemorrhage may improve (but not restore) macro- and microvascular functions and tissue oxygenation, while arginine vasopressin infusion may only improve blood pressures and result in lower overall systemic perfusion compared with low-volume saline or hemoglobin glutamer-200 treatment and worsening of anaerobic conditions in skeletal muscle.

Authors+Show Affiliations

University of Pennsylvania, School of Veterinary Medicine, Department of Clinical Studies, Section of Critical Care, New Bolton Center, Kennett Square, PA, USA. driessen@vet.upenn.eduNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

17581486

Citation

Driessen, Bernd, et al. "Effects of Low-volume Hemoglobin Glutamer-200 Versus Normal Saline and Arginine Vasopressin Resuscitation On Systemic and Skeletal Muscle Blood Flow and Oxygenation in a Canine Hemorrhagic Shock Model." Critical Care Medicine, vol. 35, no. 9, 2007, pp. 2101-9.
Driessen B, Zarucco L, Gunther RA, et al. Effects of low-volume hemoglobin glutamer-200 versus normal saline and arginine vasopressin resuscitation on systemic and skeletal muscle blood flow and oxygenation in a canine hemorrhagic shock model. Crit Care Med. 2007;35(9):2101-9.
Driessen, B., Zarucco, L., Gunther, R. A., Burns, P. M., Lamb, S. V., Vincent, S. E., Boston, R. A., Jahr, J. S., & Cheung, A. T. (2007). Effects of low-volume hemoglobin glutamer-200 versus normal saline and arginine vasopressin resuscitation on systemic and skeletal muscle blood flow and oxygenation in a canine hemorrhagic shock model. Critical Care Medicine, 35(9), 2101-9.
Driessen B, et al. Effects of Low-volume Hemoglobin Glutamer-200 Versus Normal Saline and Arginine Vasopressin Resuscitation On Systemic and Skeletal Muscle Blood Flow and Oxygenation in a Canine Hemorrhagic Shock Model. Crit Care Med. 2007;35(9):2101-9. PubMed PMID: 17581486.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Effects of low-volume hemoglobin glutamer-200 versus normal saline and arginine vasopressin resuscitation on systemic and skeletal muscle blood flow and oxygenation in a canine hemorrhagic shock model. AU - Driessen,Bernd, AU - Zarucco,Laura, AU - Gunther,Robert A, AU - Burns,Patrick M, AU - Lamb,Stephen V, AU - Vincent,Stella E, AU - Boston,Ray A, AU - Jahr,Jonathan S, AU - Cheung,Anthony T W, PY - 2007/6/22/pubmed PY - 2007/9/29/medline PY - 2007/6/22/entrez SP - 2101 EP - 9 JF - Critical care medicine JO - Crit Care Med VL - 35 IS - 9 N2 - OBJECTIVE: To test the hypothesis that low-volume resuscitation with hemoglobin glutamer-200 improves hemodynamic function and tissue oxygenation, whereas arginine vasopressin resuscitation improves blood pressures more than low-volume saline or hemoglobin glutamer infusion but compromises systemic and muscle blood flow and oxygenation. DESIGN: Randomized laboratory investigation. SETTING: University research facility. SUBJECTS: Nineteen dogs. INTERVENTIONS: Dogs were instrumented to determine heart rate; arterial, central venous, pulmonary arterial, and pulmonary arterial occlusion pressures; cardiac output; and quadriceps muscle blood flow and oxygen tension (PMo2). Total and plasma hemoglobin, oxygen content, lactate, pH, standard base excess, and arginine vasopressin levels were determined, and systemic oxygen delivery (Do2I) and extraction ratio were calculated. Measurements were made before and 30 mins following hemorrhage. Dogs were resuscitated over 60 mins with saline (8.5 mL/kg), arginine vasopressin (0.4 IU/kg bolus plus 0.08 IU x kg x min), or 1:1 diluted hemoglobin glutamer-200. Recordings were then repeated. Subsequently, animals received 30 mL/kg shed blood (60 mL x kg x hr), and recordings were repeated immediately and 1 hr later. MEASUREMENTS AND MAIN RESULTS: Hemorrhage (approximately 52 mL/kg) caused characteristic changes in hemodynamic, hematologic, systemic PMo2, and acid-base variables. Saline resuscitation increased both Do2I and muscle perfusion by 42% and 51%, while arginine vasopressin treatment reduced heart rate by 31% and increased mean arterial pressure by 22% but not cardiac output, Do2I, or muscle blood flow, resulting in a further decrease of PMo2 by 68% and worse metabolic acidosis. Hemoglobin glutamer-200 infusion caused systemic and pulmonary vasoconstriction, however, without deterioration of cardiac output, Do2I, muscle blood flow, or PMo2 despite lack of oxygen content increase. Blood transfusion restored most variables. CONCLUSIONS: Low-volume crystalloid or hemoglobin glutamer-200 resuscitation posthemorrhage may improve (but not restore) macro- and microvascular functions and tissue oxygenation, while arginine vasopressin infusion may only improve blood pressures and result in lower overall systemic perfusion compared with low-volume saline or hemoglobin glutamer-200 treatment and worsening of anaerobic conditions in skeletal muscle. SN - 0090-3493 UR - https://www.unboundmedicine.com/medline/citation/17581486/Effects_of_low_volume_hemoglobin_glutamer_200_versus_normal_saline_and_arginine_vasopressin_resuscitation_on_systemic_and_skeletal_muscle_blood_flow_and_oxygenation_in_a_canine_hemorrhagic_shock_model_ L2 - https://dx.doi.org/10.1097/01.CCM.0000277040.31978.3D DB - PRIME DP - Unbound Medicine ER -