Comparison of circulatory stress indicators in a swine model

Bodó, Michael; Rothwell, Stephen W.; Dorsey, Jennifer; Sawyer, Evelyn S.; Sipos, Kornel

doi:10.1037/e538952013-059

Cited by 3 publications

(8 citation statements)

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“…[ 30 ] Persistent elevation of the SI has been associated with a poor outcome in critically ill patients. [ 31 ] The Shock index is a sensitive indicator of left ventricular dysfunction[ 24 ] and displays variability in critical patients displaying normal vital signs[ 19 ]. Persistently elevated SI is also associated with poor outcomes in critically ill patients[ 32 ].…”

Section: Discussionmentioning

confidence: 99%

“…[ 35 ] The amount of blood lost in real-life situations is often unknown, and visually, estimated blood loss is often imprecise. [ 24 ] An uncontrolled model may be beneficial in the future. Third, the use of anesthetic was uniform in all subjects; however, the effect on cardiovascular responses is unknown.…”

Section: Discussionmentioning

confidence: 99%

“…[ 23 ] The Shock index (SI) is the ratio of heart rate (HR) to systolic blood pressure (SBP) and may be more useful in early hemorrhage than either vital sign alone. [ 24 ] The SI and vegetative balance (KI) may be useful in quantification of cardiovascular stress in HS. [ 25 ]…”

Section: Introductionmentioning

confidence: 99%

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Pyruvate dose response studies targeting the vital signs following hemorrhagic shock

Sharma

Makler

Carissa

et al. 2015

J Emerg Trauma Shock

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Objectives:To determine the optimal effective dose of sodium pyruvate in maintaining the vital signs following hemorrhagic shock (HS) in rats.Materials and Methods:Anesthetized, male Sprague-Dawley rats underwent computer-controlled HS for 30 minute followed by fluid resuscitation with either hypertonic saline, or sodium pyruvate solutions of 0.5 M, 1.0 M, 2.0 M, and 4.0 M at a rate of 5ml/kg/h (60 minute) and subsequent blood infusion (60 minute). The results were compared with sham and non- resuscitated groups. The animals were continuously monitored for mean arterial pressure, systolic and diastolic pressure, heart rate, pulse pressure, temperature, shock index and Kerdo index (KI).Results:The Sham group remained stable throughout the experiment. Non-resuscitated HS animals did not survive for the entire experiment due to non-viable vital signs and poor shock and KI. All fluids were effective in normalizing the vital signs when shed blood was used adjunctively. Sodium pyruvate 2.0 M was most effective, and 4.0 M solution was least effective in improving the vital signs after HS.Conclusions:Future studies should be directed to use 2.0 M sodium pyruvate adjuvant for resuscitation on multiorgan failure and survival rate in HS.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Pyruvate dose response studies targeting the vital signs following hemorrhagic shock

Sharma

Makler

Carissa

et al. 2015

J Emerg Trauma Shock

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“…Data processing involved 1) visual evaluation of CBF AR responses during SAP changes; 2) automated calculation of CBF AR status; 3) comparing REG integral and ICP mean values during 15 and 20 cm H 2 O PEEP; 4) status of systemic circulation was compared by student t-test, involving 30 minutes data at the start and the end of the recording. SAP and CO were compared by their correlation coefficient involving time window from 14.00 till 17.40, 5) pulse pressure (PP) was calculated as systolic-diastolic blood pressure; 6) calculation of shock index (SI: Heart rate in beats per minute/Systolic blood pressure) [ 46 ] and Kerdo index - KI: (1 − diastolic blood pressure/heart rate) + 100 [ 23 ] modified by Sipos [ 47 ] was calculated covering 4.12 hours recording time. Statistical analysis was performed in Excel (Microsoft, Redmond, WA).…”

Section: Methodsmentioning

confidence: 99%

“…The Shock index (SI) is the ratio of heart rate (HR) to systolic arterial pressure (SAP) and may be more useful in early hemorrhage than either vital sign alone [ 21 ]. The vegetative balance - Kerdo index [ 22 ] was useful in the quantification of cardiovascular stress in hemorrhagic shock [ 23 ].…”

Section: Introductionmentioning

confidence: 99%

Thoracic, peripheral, and cerebral volume, circulatory and pressure responses to PEEP during simulated hemorrhage in a pig model: a case study

Montgomery¹,

Montgomery²,

Bodó

et al. 2021

Journal of Electrical Bioimpedance

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Positive end-expiratory pressure (PEEP) is a respiratory/ventilation procedure that is used to maintain or improve breathing in clinical and experimental cases that exhibit impaired lung function. Body fluid shift movement is not monitored during PEEP application in intensive care units (ICU), which would be interesting specifically in hypotensive patients. Brain injured and hypotensive patients are known to have compromised cerebral blood flow (CBF) autoregulation (AR) but currently, there is no non-invasive way to assess the risk of implementing a hypotensive resuscitation strategy and PEEP use in these patients. The advantage of electrical bioimpedance measurement is that it is noninvasive, continuous, and convenient. Since it has good time resolution, it is ideal for monitoring in intensive care units (ICU). The basis of its future use is to establish physiological correlates. In this study, we demonstrate the use of electrical bioimpedance measurement during bleeding and the use of PEEP in pig measurement. In an anesthetized pig, we performed multimodal recording on the torso and head involving electrical bioimpedance spectroscopy (EIS), fixed frequency impedance plethysmography (IPG), and bipolar (rheoencephalography – REG) measurements and processed data offline. Challenges (n=16) were PEEP, bleeding, change of SAP, and CO2 inhalation. The total measurement time was 4.12 hours. Systemic circulatory results: Bleeding caused a continuous decrease of SAP, cardiac output (CO), and increase of heart rate, temperature, shock index (SI), vegetative - Kerdo index (KI). Pulse pressure (PP) decreased only after second bleeding which coincided with loss of CBF AR. Pulmonary arterial pressure (PAP) increased during PEEP challenges as a function of time and bleeding. EIS/IPG results: Body fluid shift change was characterized by EIS-related variables. Electrical Impedance Spectroscopy was used to quantify the intravascular, interstitial, and intracellular volume changes during the application of PEEP and simulated hemorrhage. The intravascular fluid compartment was the primary source of blood during hemorrhage. PEEP produced a large fluid shift out of the intravascular compartment during the first bleeding period and continued to lose more blood following the second and third bleeding. Fixed frequency IPG was used to quantify the circulatory responses of the calf during PEEP and simulated hemorrhage. PEEP reduced the arterial blood flow into the calf and venous outflow from the calf. Head results: CBF AR was evaluated as a function of SAP change. Before bleeding, and after moderate bleeding, intracranial pressure (ICP), REG, and carotid flow pulse amplitudes (CFa) increased. This change reflected vasodilatation and active CBF AR. After additional hemorrhaging during PEEP, SAP, ICP, REG, CFa signal amplitudes decreased, indicating passive CBF AR. 1) The indicators of active AR status by modalities was the following: REG (n=9, 56 %), CFa (n=7, 44 %), and ICP (n=6, 38 %); 2) CBF reactivity was better for REG than ICP; 3) REG and ICP correlation coefficient were high (R2 = 0.81) during CBF AR active status; 4) PRx and REGx reflected active CBF AR status. CBF AR monitoring with REG offers safety for patients by preventing decreased CBF and secondary brain injury. We used different types of bioimpedance instrumentation to identify physiologic responses in the different parts of the body (that have not been discussed before) and how the peripheral responses ultimately lead to decreased cardiac output and changes in the head. These bioimpedance methods can improve ICU monitoring, increase the adequacy of therapy, and decrease mortality and morbidity.

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A Novel Therapeutic Approach With Sodium Pyruvate on Vital Signs, Acid–Base, and Metabolic Disturbances in Rats With a Combined Blast and Hemorrhagic Shock

2022

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BackgroundBlast injuries from improvised explosive devices (IEDs) are known to cause blast traumatic brain injuries (bTBIs), hemorrhagic shock (HS), organ damage, mitochondrial dysfunction, and subsequent free radical production. A pre-citric acid cycle reagent, pyruvate, is suggested to improve mitochondrial ATP production through the activation of the mitochondrial gatekeeper enzyme “pyruvate dehydrogenase complex (PDH).” Our study aimed to investigate the role of physiologic, metabolic, and mitochondrial effects of hypertonic sodium pyruvate resuscitation in rats with a combined blast and HS injury.MethodsA pre-clinical rat model of combined injury with repetitive 20 PSI blast exposure accompanied with HS and fluid resuscitation (sodium pyruvate as metabolic adjuvant or hypertonic saline as control), followed by transfusion of shed blood was used in this study. Control sham animals (instrumental and time-matched) received anesthesia and cannulation, but neither received any injury nor treatment. The mean arterial pressure and heart rate were recorded throughout the experiment by a computerized program. Blood collected at T0 (baseline), T60 (after HS), and T180 (end) was analyzed for blood chemistry and mitochondrial PDH enzyme activity.ResultsSodium pyruvate resuscitation significantly improved the mean arterial pressure (MAP), heart rate (HR), pulse pressure (PP), hemodynamic stability (Shock index), and autonomic response (Kerdo index) after the HS and/or blast injury. Compared with the baseline values, plasma lactate and lactate/pyruvate ratios were significantly increased. In contrast, base excess BE/(HCO3-) was low and the pH was also acidotic <7.3, indicating the sign of metabolic acidosis after blast and HS in all animal groups. Sodium pyruvate infusion significantly corrected these parameters at the end of the experiment. The PDH activity also improved after the sodium pyruvate infusion.ConclusionIn our rat model of a combined blast and HS injury, hypertonic sodium pyruvate resuscitation was significantly effective in hemodynamic stabilization by correcting the acid–base status and mitochondrial mechanisms via its pyruvate dehydrogenase enzyme.

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Comparison of circulatory stress indicators in a swine model

Cited by 3 publications

References 0 publications

Pyruvate dose response studies targeting the vital signs following hemorrhagic shock

Pyruvate dose response studies targeting the vital signs following hemorrhagic shock

Thoracic, peripheral, and cerebral volume, circulatory and pressure responses to PEEP during simulated hemorrhage in a pig model: a case study

A Novel Therapeutic Approach With Sodium Pyruvate on Vital Signs, Acid–Base, and Metabolic Disturbances in Rats With a Combined Blast and Hemorrhagic Shock

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