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

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 a...

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Veröffentlicht in:Critical care medicine 2007-09, Vol.35 (9), p.2101-2109
Hauptverfasser: Driessen, Bernd, Zarucco, Laura, Gunther, Robert A, Burns, Patrick M, Lamb, Stephen V, Vincent, Stella E, Boston, Ray A, Jahr, Jonathan S, Cheung, Anthony T. W
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container_end_page 2109
container_issue 9
container_start_page 2101
container_title Critical care medicine
container_volume 35
creator Driessen, Bernd
Zarucco, Laura
Gunther, Robert A
Burns, Patrick M
Lamb, Stephen V
Vincent, Stella E
Boston, Ray A
Jahr, Jonathan S
Cheung, Anthony T. W
description 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·kg·min), or 1:1 diluted hemoglobin glutamer-200. Recordings were then repeated. Subsequently, animals received 30 mL/kg shed blood (60 mL·kg·hr), and recordings were repeated immediately and 1 hr later. MEASUREMENTS AND MAIN RESULTS:Hemorrhage (∼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.
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W</creator><creatorcontrib>Driessen, Bernd ; Zarucco, Laura ; Gunther, Robert A ; Burns, Patrick M ; Lamb, Stephen V ; Vincent, Stella E ; Boston, Ray A ; Jahr, Jonathan S ; Cheung, Anthony T. W</creatorcontrib><description>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·kg·min), or 1:1 diluted hemoglobin glutamer-200. Recordings were then repeated. Subsequently, animals received 30 mL/kg shed blood (60 mL·kg·hr), and recordings were repeated immediately and 1 hr later. MEASUREMENTS AND MAIN RESULTS:Hemorrhage (∼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.</description><identifier>ISSN: 0090-3493</identifier><identifier>EISSN: 1530-0293</identifier><identifier>DOI: 10.1097/01.CCM.0000277040.31978.3D</identifier><identifier>PMID: 17581486</identifier><identifier>CODEN: CCMDC7</identifier><language>eng</language><publisher>Hagerstown, MD: by the Society of Critical Care Medicine and Lippincott Williams &amp; Wilkins</publisher><subject>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy ; Animals ; Arginine Vasopressin - administration &amp; dosage ; Biological and medical sciences ; Blood Circulation - drug effects ; Blood Pressure - drug effects ; Blood. Blood and plasma substitutes. Blood products. Blood cells. Blood typing. Plasmapheresis. Apheresis ; Cardiac Output - drug effects ; Disease Models, Animal ; Dogs ; Emergency and intensive cardiocirculatory care. Cardiogenic shock. Coronary intensive care ; Female ; Heart Rate - drug effects ; Hemoglobins - administration &amp; dosage ; Intensive care medicine ; Male ; Medical sciences ; Muscles - blood supply ; Oxygen - metabolism ; Random Allocation ; Resuscitation - methods ; Shock, Hemorrhagic - physiopathology ; Shock, Hemorrhagic - therapy ; Transfusions. Complications. Transfusion reactions. 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W</creatorcontrib><title>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</title><title>Critical care medicine</title><addtitle>Crit Care Med</addtitle><description>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·kg·min), or 1:1 diluted hemoglobin glutamer-200. Recordings were then repeated. Subsequently, animals received 30 mL/kg shed blood (60 mL·kg·hr), and recordings were repeated immediately and 1 hr later. MEASUREMENTS AND MAIN RESULTS:Hemorrhage (∼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.</description><subject>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy</subject><subject>Animals</subject><subject>Arginine Vasopressin - administration &amp; dosage</subject><subject>Biological and medical sciences</subject><subject>Blood Circulation - drug effects</subject><subject>Blood Pressure - drug effects</subject><subject>Blood. Blood and plasma substitutes. Blood products. Blood cells. Blood typing. Plasmapheresis. Apheresis</subject><subject>Cardiac Output - drug effects</subject><subject>Disease Models, Animal</subject><subject>Dogs</subject><subject>Emergency and intensive cardiocirculatory care. Cardiogenic shock. Coronary intensive care</subject><subject>Female</subject><subject>Heart Rate - drug effects</subject><subject>Hemoglobins - administration &amp; dosage</subject><subject>Intensive care medicine</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Muscles - blood supply</subject><subject>Oxygen - metabolism</subject><subject>Random Allocation</subject><subject>Resuscitation - methods</subject><subject>Shock, Hemorrhagic - physiopathology</subject><subject>Shock, Hemorrhagic - therapy</subject><subject>Transfusions. Complications. Transfusion reactions. Cell and gene therapy</subject><issn>0090-3493</issn><issn>1530-0293</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2007</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpFkt2O0zAQhSMEYrsLr4AsJPYuZRy7dsId6u4C0iJu4DqaOHYb6sTFk7T0DXks3B-plqWR5e-cGelMlr3nMOdQ6Y_A58vl9zmkU2gNEuaCV7qci4cX2YwvBORQVOJlNgOoIBeyEjfZLdFvAC4XWrzObrhelFyWapb9e3TOmpFYcMyHfb4LfuotW9s-rHxouoGt_DRib2NeALCdjTQRG0Ls0TNC3w2W4dAyjKtuOD52SGEbLVGSpjKR6UYcuzCwdOlAo-07c5LQxno7Jps-Qd6yxofQMpemOH2Hv4eVHc7S5IXM4KnBcbQY17hKNrQOZsP60Fr_Jnvl0JN9e6l32a-nx5_Lr_nzjy_flp-fcyOqQuauaRRCwRulCwlOOSXdAltdCqWEM-Wi0gobWZSiMEa7RqMWpuSac9VabBpxl92ffbcx_JksjXXfkbHe42DDRLUqC5CylAn8dAZNDETRunobux7joeZQH3Osgdcpx_qaY33KsRYPSfzu0mVqettepZfgEvDhAiAZ9C7iYDq6chVwUVWQOHnm9sGPKbyNn_Y21muLflyfWotCqmO2Oi0LpNU5bon4D5l3u3U</recordid><startdate>200709</startdate><enddate>200709</enddate><creator>Driessen, Bernd</creator><creator>Zarucco, Laura</creator><creator>Gunther, Robert A</creator><creator>Burns, Patrick M</creator><creator>Lamb, Stephen V</creator><creator>Vincent, Stella E</creator><creator>Boston, Ray A</creator><creator>Jahr, Jonathan S</creator><creator>Cheung, Anthony T. W</creator><general>by the Society of Critical Care Medicine and Lippincott Williams &amp; Wilkins</general><general>Lippincott</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>200709</creationdate><title>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</title><author>Driessen, Bernd ; Zarucco, Laura ; Gunther, Robert A ; Burns, Patrick M ; Lamb, Stephen V ; Vincent, Stella E ; Boston, Ray A ; Jahr, Jonathan S ; Cheung, Anthony T. W</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3924-fbb6a021b67240f6f64f5ad783663fc85976ab42832cc7fb7a73c817116deabb3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2007</creationdate><topic>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy</topic><topic>Animals</topic><topic>Arginine Vasopressin - administration &amp; dosage</topic><topic>Biological and medical sciences</topic><topic>Blood Circulation - drug effects</topic><topic>Blood Pressure - drug effects</topic><topic>Blood. Blood and plasma substitutes. Blood products. Blood cells. Blood typing. Plasmapheresis. Apheresis</topic><topic>Cardiac Output - drug effects</topic><topic>Disease Models, Animal</topic><topic>Dogs</topic><topic>Emergency and intensive cardiocirculatory care. Cardiogenic shock. Coronary intensive care</topic><topic>Female</topic><topic>Heart Rate - drug effects</topic><topic>Hemoglobins - administration &amp; dosage</topic><topic>Intensive care medicine</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Muscles - blood supply</topic><topic>Oxygen - metabolism</topic><topic>Random Allocation</topic><topic>Resuscitation - methods</topic><topic>Shock, Hemorrhagic - physiopathology</topic><topic>Shock, Hemorrhagic - therapy</topic><topic>Transfusions. Complications. Transfusion reactions. Cell and gene therapy</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Driessen, Bernd</creatorcontrib><creatorcontrib>Zarucco, Laura</creatorcontrib><creatorcontrib>Gunther, Robert A</creatorcontrib><creatorcontrib>Burns, Patrick M</creatorcontrib><creatorcontrib>Lamb, Stephen V</creatorcontrib><creatorcontrib>Vincent, Stella E</creatorcontrib><creatorcontrib>Boston, Ray A</creatorcontrib><creatorcontrib>Jahr, Jonathan S</creatorcontrib><creatorcontrib>Cheung, Anthony T. W</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Critical care medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Driessen, Bernd</au><au>Zarucco, Laura</au><au>Gunther, Robert A</au><au>Burns, Patrick M</au><au>Lamb, Stephen V</au><au>Vincent, Stella E</au><au>Boston, Ray A</au><au>Jahr, Jonathan S</au><au>Cheung, Anthony T. W</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>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</atitle><jtitle>Critical care medicine</jtitle><addtitle>Crit Care Med</addtitle><date>2007-09</date><risdate>2007</risdate><volume>35</volume><issue>9</issue><spage>2101</spage><epage>2109</epage><pages>2101-2109</pages><issn>0090-3493</issn><eissn>1530-0293</eissn><coden>CCMDC7</coden><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·kg·min), or 1:1 diluted hemoglobin glutamer-200. Recordings were then repeated. Subsequently, animals received 30 mL/kg shed blood (60 mL·kg·hr), and recordings were repeated immediately and 1 hr later. MEASUREMENTS AND MAIN RESULTS:Hemorrhage (∼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.</abstract><cop>Hagerstown, MD</cop><pub>by the Society of Critical Care Medicine and Lippincott Williams &amp; Wilkins</pub><pmid>17581486</pmid><doi>10.1097/01.CCM.0000277040.31978.3D</doi><tpages>9</tpages></addata></record>
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subjects Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy
Animals
Arginine Vasopressin - administration & dosage
Biological and medical sciences
Blood Circulation - drug effects
Blood Pressure - drug effects
Blood. Blood and plasma substitutes. Blood products. Blood cells. Blood typing. Plasmapheresis. Apheresis
Cardiac Output - drug effects
Disease Models, Animal
Dogs
Emergency and intensive cardiocirculatory care. Cardiogenic shock. Coronary intensive care
Female
Heart Rate - drug effects
Hemoglobins - administration & dosage
Intensive care medicine
Male
Medical sciences
Muscles - blood supply
Oxygen - metabolism
Random Allocation
Resuscitation - methods
Shock, Hemorrhagic - physiopathology
Shock, Hemorrhagic - therapy
Transfusions. Complications. Transfusion reactions. Cell and gene therapy
title 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
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