A Quantitative Analysis of Transcapillary Refill in Severe Hemorrhagic Hypotension in Dogs

Prist, Ricardo; Rocha-e-Silva, Maurício; Scalabrini, A; Coelho, I. J. C.; Franca, E. S. V.; Meneghetti, Cinthya Maria Schneider; Braga, G. A.

doi:10.1097/00024382-199403000-00006

Cited by 21 publications

(20 citation statements)

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“…TR following hypertonic saline resuscitation has been demonstrated in animal models of controlled hemorrhage 9–10,12,50. In the present study, hemorrhage led to transcapillary refill during the initial fifteen minutes after hemorrhage started in all groups.…”

Section: Discussionsupporting

confidence: 53%

Blood Loss and Transcapillary Refill in Uncontrolled Treated Hemorrhage in Dogs

Sallum

Sinozaki

Calil

et al. 2010

Clinics

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OBJETIVE:This study evaluated retroperitoneal hematomas produced by bilateral injury of iliac arteries (uncontrolled hemorrhage), blood volume loss, transcapillary refill, the effects of volume replacement on retroperitoneal bleeding and the hemodynamic changes with and without treatment.METHODS:Initial blood volume was determined with Tc99m-labelled red cells, and bleeding was evaluated by means of a portable scintillation camera positioned over the abdomen. Previously splenectomized mongrel dogs (16.8 ± 2.2 kg) were submitted to hemorrhage for 30 minutes and randomized into three groups: I - no treatment (n=7); II - treatment with 32 mL/kg of Lactated Ringer’s for three to five minutes (n=7); and III - treatment with 4 mL/kg of 7.5% NaCl plus 6.0% dextran 70 for three to five minutes (n=7). They were studied for an additional 45 minutes.RESULTS:Volume replacement produced transitory recovery in hemodynamic variables, including mean pulmonary artery pressure, pulmonary capillary wedge pressure and cardiac index, with significant increase in dogs treated with 32 mL/kg of Lactated Ringer’s and 7.5% NaCl plus 6.0% dextran 70 (p<0.001, against no treatment), along with a decrease (p<0.001) in the systemic vascular resistance index. Groups II and III had significant initial decreases in hematocrit and hemoglobin. The treated dogs (groups II and III) presented rebleeding, which was greater during treatment with 32 mL/kg of Lactated Ringer’s (group II).CONCLUSIONS:Despite the rebleeding observed in treated groups, the utilization of hypertonic saline solution with dextran proved to be effective in the initial reanimation, producing evident transcapillary refill, while the Lactated Ringer’s solution produced capillary extravasation and was ineffective in the initial volume replacement in this model of uncontrolled hemorrhage.

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Section: Discussionsupporting

confidence: 53%

Blood Loss and Transcapillary Refill in Uncontrolled Treated Hemorrhage in Dogs

Sallum

Sinozaki

Calil

et al. 2010

Clinics

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“…In our study, the SVR showed an elevation tendency in its values between the BM and M20, however, without statistical significance. The use of hypertonic solutions determines a drop in systemic vascular resistance from the vasodilatory effects of these solutions [34,36].…”

Section: Discussionmentioning

confidence: 99%

Intraosseous Hypertonic Saline Solution for Resuscitation of Uncontrolled, Exsanguinating Liver Injury in Young Swine

Carrera

Pacheco²,

Caruso³

et al. 2004

Eur Surg Res

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Fluid resuscitation administered before hemorrhage control for trauma victims sustaining blunt abdominal injury is controversial. Prehospital fluid resuscitation is limited by difficulty in delivering large volumes of fluid in the field and time delays associated with gaining vascular access. Venous access is often a clinical dilemma in severely hypovolemic children. Intraosseous infusion is considered a useful technique for the administration of fluids in emergency situations when peripheral intravascular access is not possible. This study investigated the effectiveness of intraosseous versus intravenous infusion of hypertonic saline solution in an uncontrolled hemorrhagic shock swine model. We also tested the effect of the different sites of infusion on the intra-abdominal bleeding. Relevant hemodynamic parameters were monitored and blood samples were collected. After liver injury, 20 anesthetized immature pigs were randomized to three groups: intraosseous access, intravenous access and control. After 20 min of uncontrolled hemorrhage, the hypertonic saline solution begins in the intraosseous access and intravenous access groups of animals. Thirty minutes later, the animals were killed and intra-abdominal blood loss was measured. All the pigs presented lower pressures and lower cardiac output after 20 min of hemorrhagic shock. The intravenous and intraosseous access groups did not show a better hemodynamic performance after 10 min of fluid resuscitation. At the end of the experiment, all animals were hemodynamically similar without an improved answer to a fluid resuscitation. There were no significant differences between groups regarding intra-abdominal blood loss. It was concluded that the hypertonic saline solution in this experimental model did not promote hemodynamic improvement and there were no differences between the two sites of fluid resuscitation regarding intra-abdominal blood loss.

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“…15−18 Perhaps hemodynamic deterioration occurs in abrupt transitions rather than in a steady fashion. Indeed, during the first hour after hemorrhage, transcapillary fluid shifts of up to 1 or 2 liters can occur, 32 counteracting slow hemorrhagic volume loss. Certain neurohumeral compensations are also activated during this time frame.…”

Section: Limitationsmentioning

confidence: 99%

Exploration of Prehospital Vital Sign Trends for the Prediction of Trauma Outcomes

Chen

Reisner

Gribok

et al. 2009

Prehospital Emergency Care

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Objectives. We explored whether there are diagnostically useful temporal trends in prehospital vital signs of trauma patients. Methods. Vital signs were monitored during transport to a level I trauma center and electronically archived. Retrospectively, we identified reliable vital signs recorded from the 0-to 7-minute interval and from the 14-to 21-minute interval during transport, and, for each subject, we computed the temporal differences between the two intervals' vital signs, the intrasubject 95% data ranges, the values during the initial 2 minutes, and the 21-minute overall means. We tested for differences between subjects with major hemorrhage versus control subjects, and computed receiveroperating characteristic (ROC) curves. We conducted sensitivity analyses, exploring alternative clinical outcomes, temporal windows, and methods of identifying reliable data. Results. Comparing major hemorrhage cases versus controls, there were no discriminatory differences in temporal vital sign trends. Hemorrhage cases had significantly wider intrasubject data ranges for systolic blood pressure (SBP), respiratory rate (RR), and shock index (SI) versus controls. All results were consistent in several sensitivity analyses. Conclusions. Our findings add to a growing body of evidence that prehospital vital sign trends over 21 minutes or less are unlikely to be diagnostically useful because of substantial nondirectional fluctuations in vital signs that would obscure any subtle, progressive temporal trends. SBP, RR, and SI values were significantly different for high-acuity patients, and had more variability. Taken together, these findings suggest that higher-acuity patients experience episodes of instability rather than gradual, steady decline. Measures that account for data variability, such as taking the average of multiple measurements, may improve the diagnostic utility of prehospital vital signs.

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A Quantitative Analysis of Transcapillary Refill in Severe Hemorrhagic Hypotension in Dogs

Cited by 21 publications

References 0 publications

Blood Loss and Transcapillary Refill in Uncontrolled Treated Hemorrhage in Dogs

Blood Loss and Transcapillary Refill in Uncontrolled Treated Hemorrhage in Dogs

Intraosseous Hypertonic Saline Solution for Resuscitation of Uncontrolled, Exsanguinating Liver Injury in Young Swine

Exploration of Prehospital Vital Sign Trends for the Prediction of Trauma Outcomes

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