Early Hemodynamic Changes during Uncontrolled Intra-Abdominal Bleeding

Riddez, Louis; Johnson, Lenworth N.; Hahn, Robert G.

doi:10.1159/000008617

Cited by 31 publications

(8 citation statements)

References 10 publications

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“…Different treatment groups were confirmed to be comparable before the randomization by ANOVA in our series. We observed a protracted hemorrhage lasting 6 to 7 min, compared to former studies on uncontrolled hemorrhages from the abdominal aorta where the bleeding stopped at approximately 3 min after injury [11,28]. The prolonged bleeding time may also be explained by the venous incapacity of vasoconstriction.…”

Section: Discussionsupporting

confidence: 41%

A Pilot Study on Early Versus Delayed Hypertonic Saline Dextran Resuscitation in a Porcine Model of Near-Lethal Liver Injury: Early Hemodynamic Response and Short-Term Survival

Talving

Riddez

2006

Journal of Surgical Research

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Section: Discussionsupporting

confidence: 41%

A Pilot Study on Early Versus Delayed Hypertonic Saline Dextran Resuscitation in a Porcine Model of Near-Lethal Liver Injury: Early Hemodynamic Response and Short-Term Survival

Talving

Riddez

2006

Journal of Surgical Research

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“…Injury to a large blood vessel results in the formation of a thrombus that adheres to the outer surface of the vessel and the surrounding tissue. 29,30 In pigs, this immature clot arrests the hemorrhage within 4 min in the aorta, 4,5,15,16 while liver injury might require twice as long time. 31 However, mechanical and chemical forces can apparently disturb stabilization of the clot.…”

Section: Pathophysiologymentioning

confidence: 99%

“…The double flow probe method showed that the rate of the initial hemorrhage decreased in an exponential manner and stopped completely within 4 minutes (half-time 40 seconds) in a pig weighing 20 kg 4 (Fig. 2).…”

Section: Studies In Pigsmentioning

confidence: 99%

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Fluid therapy in uncontrolled hemorrhage – what experimental models have taught us

Hahn

2012

Acta Anaesthesiol Scand

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Intravenous fluid is life-saving in hypovolemic shock, but fluid sometimes aggravates the bleeding. During the past 25 years, animal models have helped our understanding of the mechanisms involved in this unexpected effect. A key issue is that vasoconstriction is insufficient to arrest the bleeding when damage is made to a major blood vessel. ‘Uncontrolled hemorrhage’ is rather stopped by a blood clot formed at the outside surface of the vessel, and the immature clot is sensitive to mechanical and chemical interactions. The mortality increases if rebleeding occurs. In the aortic tear model in swine, hemorrhage volume and the mortality increase from effective restoration of the arterial pressure. The mortality vs. amount of fluid curve is U-shaped with higher mortality at either end. Without any fluid at all, irreversible shock causes death provided the hemorrhage is sufficiently large. Crystalloid fluid administered in a 3 : 1 proportion to the amount of lost blood initiates serious rebleeding. Hypertonic saline 7.5% in 6% dextran 70 (HSD) also provokes rebleeding resulting in higher mortality in the recommended dosage of 4 ml/kg. Uncontrolled hemorrhage models in rats, except for the ‘cut-tail’ model, confirm the results from swine. To avoid rebleeding, fluid programs should not aim to fully restore the arterial pressure, blood flow rates, or blood volume. For a hemorrhage of 1000 ml, computer simulations show that deliberate hypovolemia (−300 ml) would be achieved by infusing 600–750 ml crystalloid fluid over 20–30 min or 100 ml of HSD over 10–20 min in an adult male

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“…Only one prior model has demonstrated the timing of hemorrhage cessation. 27,28 In that study spontaneous cessation of hemorrhage occurred 3 minutes after a 5-mm laceration was created in the abdominal aorta of a swine model. We suggest that discrepancies in the timing of spontaneous cessation of hemorrhage between these two models were due to two factors.…”

Section: Discussionmentioning

confidence: 99%

Effects of Delaying Fluid Resuscitation on an Injury to the Systemic Arterial Vasculature

Holmes

Sakles

Lewis

et al. 2002

Academic Emergency Medicine

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Abstract. Objectives:To determine the effects of delaying fluid on the rate of hemorrhage and hemodynamic parameters in an injury involving the arterial system. Methods: Twenty-one adult, anesthetized sheep underwent left anterior thoracotomy and transection of the left internal mammary artery. A chest tube was inserted into the thoracic cavity to provide a continuous measurement of blood loss. The animals were randomly assigned to one of three resuscitation protocols: 1) no fluid resuscitation (NR), 2) standard fluid resuscitation (SR) begun 15 minutes after injury, or 3) delayed fluid resuscitation (DR) begun 30 minutes after injury. All of the animals in the two resuscitation groups received 60 mL/kg of lactated Ringer's solution over 30 minutes. Blood loss and hemodynamic parameters were measured throughout the experiment. Results: Total hemorrhage volume (mean Ϯ SD) at the end of the experiment was significantly lower (p = 0.006) in the NR group (1,499 Ϯ 311 mL) than in the SR group (3,435 Ϯ 721 mL) or the DR group (2,839 Ϯ 1549 mL). Rate of hemorrhage followed changes in mean arterial pressure in all groups. Hemorrhage spontaneously ceased significantly sooner (p = 0.007) in the NR group (21 Ϯ 14 minutes) and the DR group (20 Ϯ 15 minutes) than in the SR group (54 Ϯ 4 minutes). In the DR group, after initial cessation of hemorrhage, hemorrhage recurred in five of six animals (83%) with initiation of fluid resuscitation. Maximum oxygen (O 2 ) delivery in each group after injury was as follows: 101 Ϯ 34 mL O 2 /kg/min at 45 minutes in the DR group, 51 Ϯ 20 mL O 2 /kg/min at 30 minutes in the SR group, and 35 Ϯ 8 mL O 2 /kg/min at 60 minutes in the NR group. Conclusions: Rates of hemorrhage from an arterial injury are related to changes in mean arterial pressure. In this animal model, early aggressive fluid resuscitation in penetrating thoracic trauma exacerbates total hemorrhage volume. Despite resumption of hemorrhage from the site of injury, delaying fluid resuscitation results in the best hemodynamic parameters.

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Early Hemodynamic Changes during Uncontrolled Intra-Abdominal Bleeding

Cited by 31 publications

References 10 publications

A Pilot Study on Early Versus Delayed Hypertonic Saline Dextran Resuscitation in a Porcine Model of Near-Lethal Liver Injury: Early Hemodynamic Response and Short-Term Survival

A Pilot Study on Early Versus Delayed Hypertonic Saline Dextran Resuscitation in a Porcine Model of Near-Lethal Liver Injury: Early Hemodynamic Response and Short-Term Survival

Fluid therapy in uncontrolled hemorrhage – what experimental models have taught us

Effects of Delaying Fluid Resuscitation on an Injury to the Systemic Arterial Vasculature

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