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

Holmes, James F.; Sakles, John C.; Lewis, Greg; Wisner, David H.

doi:10.1111/j.1553-2712.2002.tb01317.x

Cited by 27 publications

(10 citation statements)

References 24 publications

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“…20 Furthermore, studies have shown that the resuscitation rate affects the hemorrhage rate before hemostasis has been achieved. 21,22 It is plausible that blunt and penetrating mechanisms of injury differ because of different hemorrhage rates yielding different physiologic and immunologic responses. In addition, the tissue injury associated with each mechanism of injury is likely different, with less secondary injury usually associated with lowenergy penetrating weapons.…”

Section: Figmentioning

confidence: 99%

The Association between Gender and Mortality among Trauma Patients as Modified by Age

George

McGwin

Metzger

et al. 2003

The Journal of Trauma: Injury, Infection, and Critical Care

133

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Section: Figmentioning

confidence: 99%

The Association between Gender and Mortality among Trauma Patients as Modified by Age

George

McGwin

Metzger

et al. 2003

The Journal of Trauma: Injury, Infection, and Critical Care

133

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“…(Table 1) This likely suggests a degree of auto resuscitation or mild dilution taking place during the hemorrhagic shock period which may have been amplified by continuous maintenance of hypotensive blood pressure by selective blood draws and normal saline titration [27]. …”

Section: Resultsmentioning

confidence: 99%

Systemic central venous oxygen saturation is associated with clot strength during traumatic hemorrhagic shock: A preclinical observational model

White

Martin

Shin

et al. 2010

Scand J Trauma Resusc Emerg Med

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BackgroundClot strength by Thrombelastography (TEG) is associated with mortality during trauma and has been linked to severity of tissue hypoperfusion. However, the optimal method for monitoring this important relationship remains undefined. We hypothesize that oxygen transport measurements will be associated with clot strength during traumatic shock, and test this hypothesis using a swine model of controlled traumatic shock.MethodsN = 33 swine were subjected to femur fracture and hemorrhagic shock by controlled arterial bleeding to a predetermined level of oxygen debt measured by continuous indirect calorimetry. Hemodynamics, oxygen consumption, systemic central venous oxygenation (ScvO2), base excess, lactate, and clot maximal amplitude by TEG (TEG-MA) as clot strength were measured at baseline and again when oxygen debt = 80 ml/kg during shock. Oxygen transport and metabolic markers of tissue perfusion were then evaluated for significant associations with TEG-MA. Forward stepwise selection was then used to create regression models identifying the strongest associations between oxygen transport and TEG-MA independent of other known determinants of clot strength.ResultsMultiple markers of tissue perfusion, oxygen transport, and TEG-MA were all significantly altered during shock compared to baseline measurements (p < 0.05). However, only ScvO2 demonstrated a strong bivariate association with TEG-MA measured during shock (R = 0.7, p < 0.001). ScvO2 measured during shock was also selected by forward stepwise selection as an important covariate in linear regression models of TEG-MA after adjusting for the covariates fibrinogen, pH, platelet count, and hematocrit (Whole model R2 = 0.99, p ≤ 0.032).ConclusionsAmong multiple measurements of oxygen transport, only ScvO2 was found to retain a significant association with TEG-MA during shock after adjusting for multiple covariates. ScvO2 should be further studied for its utility as a clinical marker of both tissue hypoxia and clot formation during traumatic shock.

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“…Some models used to test hemostatic dressings include fluid administration to achieve a target arterial pressure which may require the infusion of large volumes of crystalloid [7,9,11,12]. Although somewhat controversial, high-volume or high-flow infusions after a vascular injury tend to increase both blood loss and mortality, whereas delayed or minimal resuscitation results in less blood loss and improved survival in some models [13][14][15]. We chose to avoid this issue by giving relatively small volumes of fluid.…”

Section: Discussionmentioning

confidence: 97%

Dextran Polymer Hemostatic Dressing Improves Survival in Liver Injury Model

Clay

Zierold

Grayson

et al. 2009

Journal of Surgical Research

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

Cited by 27 publications

References 24 publications

The Association between Gender and Mortality among Trauma Patients as Modified by Age

The Association between Gender and Mortality among Trauma Patients as Modified by Age

Systemic central venous oxygen saturation is associated with clot strength during traumatic hemorrhagic shock: A preclinical observational model

Dextran Polymer Hemostatic Dressing Improves Survival in Liver Injury Model

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