The value of volume substitution in patients with septic and haemorrhagic shock with respect to the microcirculation

Siegemund, Martin; Hollinger, Alexa; Gebhard, Eva Caroline; Scheuzger, Jonas; Bolliger, Daniel

doi:10.4414/smw.2019.20007

Cited by 6 publications

(5 citation statements)

References 81 publications

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“…Although the volume of fluid between OMX and vehicle was matched, OMX is a PEGylated protein-containing product, and both protein and PEG have oncotic properties; thus, neither protein-nor PEGrelated oncotic pressures were controlled. In the absence of blood products, various methods to replace volume and increase oncotic pressure have been extensively evaluated, with no clear benefit to colloid over crystalloid replacement for shock resuscitation (49)(50)(51)(52). Second, although biochemical surrogates of oxygen delivery were measured, cardiac output was not directly determined during these studies, negating the ability to directly calculate vascular resistance.…”

Section: Discussionmentioning

confidence: 99%

OMX: A Novel Oxygen Delivery Biotherapeutic Improves Outcomes in an Ovine Model of Controlled Hemorrhagic Shock

Maltepe,

Smith,

Boehme

et al. 2024

Shock

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Hemorrhagic shock is a major source of morbidity and mortality worldwide. While whole blood or blood product transfusion is a first line treatment, maintaining robust supplies presents significant logistical challenges, particularly in autere environments. OMX is a novel non-hemoglobin (Hb)-based oxygen carrier derived from the H-NOX (Heme-Nitric Oxide/Oxygen binding) protein family. Due to their engineered oxygen (O2) affinities, OMX proteins only deliver O2 to severely hypoxic tissues. Additionally, unlike Hb-based oxygen carriers, OMX proteins do not scavenge nitric oxide in the vasculature. To determine the safety and efficacy of OMX in supporting tissue oxygen delivery and cardiovascular function in a large-animal model of controlled hemorrhage, 2-3-week-old lambs were anesthetized, intubated, and mechanically ventilated. Hypovolemic shock was induced by acute hemorrhage to obtain a 50% reduction over 30 minutes. Vehicle (n = 16) or 400 mg/kg OMX (n = 13) treatment was administered over 15 minutes. Hemodynamics, arterial blood gases, and laboratory values were monitored throughout the 6 hour study. Comparisons between groups were made using T tests, Wilcoxon Rank Sum test, and Fisher’s Exact test. Survival was assessed using Kaplan Meier curves and the Log-Rank test. We found that OMX was well-tolerated and significantly improved lactate and base deficit trends, and hemodynamic indices (p < 0.05). Median survival time was greater in the OMX-treated group (4.7 vs. 6.0 hr., p < 0.003), and overall survival was significantly increased in the OMX-treated group (25% vs. 85%, p = 0.004). We conclude that OMX is well-tolerated and improves metabolic, hemodynamic and survival outcomes in an ovine model of controlled hemorrhagic shock.

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Section: Discussionmentioning

confidence: 99%

OMX: A Novel Oxygen Delivery Biotherapeutic Improves Outcomes in an Ovine Model of Controlled Hemorrhagic Shock

Maltepe,

Smith,

Boehme

et al. 2024

Shock

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“…Nevertheless, based on our observations, it seems that in the event of a delay in providing HR and achieving surgical control, balanced crystalloids may be a better choice than colloids for replenishing lost intravascular volume. Even more so, since the supposedly superior volume effect of gelatines is repeatedly undermined [ 26 , 27 ].…”

Section: Discussionmentioning

confidence: 99%

In Vivo Effects of Balanced Crystalloid or Gelatine Infusions on Functional Parameters of Coagulation and Fibrinolysis: A Prospective Randomized Crossover Study

Wiórek

Mazur

Żurawska

et al. 2022

JPM

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Prudent administration of fluids helps restore or maintain hemodynamic stability in the setting of perioperative blood loss. However, fluids may arguably exacerbate the existing coagulopathy. We sought to investigate the influence of balanced crystalloid and synthetic gelatine infusions on coagulation and fibrinolysis in healthy volunteers. This prospective randomized crossover study included 25 males aged 18–30 years. Infusions performed included 20 mL/kg of a balanced crystalloid solution (Optilyte®) or 20 mL/kg of gelatine 26.500 Da (Geloplasma®) in a random order over a period of 2 weeks. Laboratory analysis included conventional coagulation parameters and rotational thromboelastometry (ROTEM) assays. We confirmed a decrease in fibrinogen concentration and the number of platelets, and prolongation of PT after infusions. Compared to baseline values, differences in the ROTEM assays’ results after infusions signified the decrease in coagulation factors and fibrinogen concentration, causing impaired fibrin polymerization and clot structure. The ROTEM indicator of clot lysis remained unaffected. In the case of both Optilyte® and Geloplasma®, the results suggested relevant dilution. Gelatine disrupted the process of clot formation more than balanced crystalloid. Infusions of both crystalloid and saline-free colloid solutions causing up to 30% blood dilution cause significant dilution of the coagulation factors, platelets, and fibrinogen. However, balanced crystalloid infusion provides less infusion-induced coagulopathy compared to gelatine.

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“…Isotonic and hypertonic crystalloid solutions continue to be investigated in order to rapidly restore hemodynamics, reduce the amount of fluid administered in order minimize hemodilution, and tissue edema, and lessen the development of disseminated intravascular coagulation ( 58 – 62 , 236 , 237 ). Novel therapies that mimic natural hemostatic mechanisms ( 68 ) or reduce vascular leakage ( 238 – 240 ) are being developed and solutions that increase tissue oxygenation (e.g., hemoglobin) and restore microcirculatory blood flow continue to evolve ( 241 – 243 ). Future fluids should protect or repair the endothelium ( 224 , 228 , 238 , 244 , 245 ).…”

Section: New Horizonsmentioning

confidence: 99%

Editorial: Fluid Therapy in Animals: Physiologic Principles and Contemporary Fluid Resuscitation Considerations

2021

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The value of volume substitution in patients with septic and haemorrhagic shock with respect to the microcirculation

Cited by 6 publications

References 81 publications

OMX: A Novel Oxygen Delivery Biotherapeutic Improves Outcomes in an Ovine Model of Controlled Hemorrhagic Shock

OMX: A Novel Oxygen Delivery Biotherapeutic Improves Outcomes in an Ovine Model of Controlled Hemorrhagic Shock

In Vivo Effects of Balanced Crystalloid or Gelatine Infusions on Functional Parameters of Coagulation and Fibrinolysis: A Prospective Randomized Crossover Study

Editorial: Fluid Therapy in Animals: Physiologic Principles and Contemporary Fluid Resuscitation Considerations

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