Central venous oxygen saturation and carbon dioxide gap as resuscitation targets in a hemorrhagic shock

Abstract

In this SV-guided bleeding and fluid resuscitation model, both ScvO2 and dCO2 correlated well with changes in SV, but only the dCO2 returned to its baseline, normal value, while ScvO2 remained significantly lower than at baseline. These results suggest that dCO2 may be a good hemodynamic endpoint of resuscitation, while ScvO2 is not strictly a hemodynamic parameter, but rather an indicator of the balance between oxygen delivery and consumption.

Multimodal individualized concept of hemodynamic monitoring

“…These results were further confirmed by trauma victims, wherein patients in whom lactate levels normalized within the first 24 h, the mortality was 10%, as compared with those patients in whom it took 48 h, where mortality was as high as 67% [37]. In a recent experimental hemorrhage and resuscitation model on pigs, we found that considerable changes of lactate level were well beyond the suggested 6-h time frame [17]. Significant increase during and after bleeding and then significant decreases during resuscitation were observed between the observation periods of 20 min.…”

“…Cardiac output and stroke volume as resuscitation endpoints In two recent experiments, we investigated CO and stroke volume (SV) guided hemorrhage and fluid resuscitation in a porcine model [17,18 & ]. After baseline measurements, animals were bled until SV index (SVI) dropped by 50%, after which animals were resuscitated in four steps till baseline cardaic index (CI) and SVI values were reached.…”

Application of pulsed arterial resuscitation in a rabbit model of hemorrhagic shock

“…Irrespective of whether the traditional liberal fluid resuscitation or the newly proposed restricted fluid resuscitation method is used, a large amount of resuscitation fluids such as crystalloids, hypertonic saline and synthetic colloids need to be infused in a short time. [2,4,[13][14][15] However, because of the high risk of peripheral venous collapse in these patients, the implementation of both these methods is difficult. In addition, the liquid is infused into a vein and thus cannot directly increase the perfusion to the heart, brain, kidney, and other organs; furthermore, the sudden rise in intravascular hydrostatic pressure and continuing decrease in plasma colloid osmotic pressure can lead to tissue edemas, such as pulmonary edema and cerebral edema, associated with increased intracranial pressure.…”

“…In addition, the liquid is infused into a vein and thus cannot directly increase the perfusion to the heart, brain, kidney, and other organs; furthermore, the sudden rise in intravascular hydrostatic pressure and continuing decrease in plasma colloid osmotic pressure can lead to tissue edemas, such as pulmonary edema and cerebral edema, associated with increased intracranial pressure. [2,4,14,16] Rectifying tissue edema caused by fluid overload is currently a popular topic in fluid resuscitation research. [1,15] In recent years, the available arterial puncture procedures have gradually become more sophisticated.…”

Macro-hemodynamic targets and hemostatic effects of fluid resuscitation during experimental hemorrhagic shock

“…Recent clinical investigations [55,56] showed positive effects of SV optimization by SVV/PPV, and in our previously set bleeding-resuscitation animal model [57], SVV/PPV were well-established indicators of fluid responsiveness. Therefore in this study, SVV was the primary outcome variable as the closest to predict fluid responsiveness, hence hypovolemia.…”