Hemorrhagic shock with fixed hypotension and with spontaneous recovery of blood pressure. A comparison of two shock models

Hemodynamic responses elicited by systemic injections of isotonic and hypertonic saline in hemorrhaged rats

PURPOSE

The objectives of this study were (i) to characterize the hemodynamic responses caused by controlled hemorrhage (HEM) in pentobarbital-anesthetized rats, and (ii) to determine the responses elicited by systemic bolus injections of isotonic saline (0.15M) or hypertonic saline (3M) given 5min after completion of HEM.

RESULTS

Controlled HEM (4.3±0.2ml/rat at 1.5ml/min) resulted in a pronounced and sustained fall in mean arterial blood pressure (MAP) to about 40mmHg. The fall in MAP was associated with a reduction in hindquarter vascular resistance (HQR) but no changes in renal (RR) or mesenteric (MR) vascular resistances. Systemic injections of isotonic saline (96-212μmol/kg i.v., in 250-550μl) did not produce immediate responses but promoted the recovery of MAP to levels below pre-HEM values. Systemic injections of hypertonic saline (750-3000μmol/kg, i.v., in 250-550μl) produced immediate and pronounced falls in MAP, RR, MR and especially HQR of 30-120s in duration. However, hypertonic saline prompted a full recovery of MAP, HQR and RR to pre-HEM levels and an increase in MR to levels above pre-HEM values.

CONCLUSIONS

This study demonstrates that (i) HEM induced a pronounced fall in MAP which likely involved a fall in cardiac output and HQR, (ii) isotonic saline did not fully normalize MAP, and (iii) hypertonic saline produced dramatic initial responses, and promoted normalization of MAP probably by restoring blood volume and cardiac output through sequestration of fluid from intracellular compartments.

Hemodynamic responses elicited by gamma2-MSH or blood replacement in hemorrhaged rats

BACKGROUND

Systemic injections of compounds such as gamma(2)-melanocyte-stimulating hormone (gamma(2)-MSH), which increase sympathetic neurogenic vasoconstriction, may be beneficial in treating hemorrhage-induced hypotension.

METHODS

This study characterized (1) the hemodynamic responses elicited by systemic injections of gamma(2)-MSH in pentobarbital-anesthetized hemorrhaged rats, and (2) the hemodynamic responses elicited by the replacement of withdrawn blood in these rats.

RESULTS

Controlled hemorrhage (4.8 +/- 0.3 mL/rat at 1.5 mL/min) resulted in a pronounced and sustained fall in mean arterial blood pressure (MAP). The fall in MAP was associated with a reduction in heart rate (HR) and hindquarter (HQR) vascular resistance but no changes in mesenteric (MR) or renal (RR) vascular resistances. Systemic injections of gamma(2)-MSH (10-40 microg/kg, i.v.) produced dose-dependent increases in HR, MAP, and vascular resistances of 20 to 60 s in duration in the hemorrhaged rats. In contrast, injection of the withdrawn blood produced an immediate and sustained increase in MAP, which was associated with a pronounced vasodilation in the hindquarter bed but no changes in MR or RR.

CONCLUSIONS

These findings suggest that although gamma(2)-MSH elicits pressor and vasoconstrictor responses in hemorrhaged rats, the bolus injection of this peptide may not in itself be an effective strategy for the sustained restoration of MAP in these rats. Moreover, although blood replacement effectively restores MAP via increases in cardiac output rather than total peripheral resistance, it appears that this manipulation produces an active vasodilation in the hindquarter bed. The possibility that this vasodilation involves a sympathetic neurogenic vasodilator system, which innervates the hindlimb vascular bed but not mesenteric or renal vascular beds, will be discussed.

Bench-to-bedside review: oxygen debt and its metabolic correlates as quantifiers of the severity of hemorrhagic and post-traumatic shock

Evidence is increasing that oxygen debt and its metabolic correlates are important quantifiers of the severity of hemorrhagic and post-traumatic shock and and may serve as useful guides in the treatment of these conditions. The aim of this review is to demonstrate the similarity between experimental oxygen debt in animals and human hemorrhage/post-traumatic conditions, and to examine metabolic oxygen debt correlates, namely base deficit and lactate, as indices of shock severity and adequacy of volume resuscitation. Relevant studies in the medical literature were identified using Medline and Cochrane Library searches. Findings in both experimental animals (dog/pig) and humans suggest that oxygen debt or its metabolic correlates may be more useful quantifiers of hemorrhagic shock than estimates of blood loss, volume replacement, blood pressure, or heart rate. This is evidenced by the oxygen debt/probability of death curves for the animals, and by the consistency of lethal dose (LD)_25,50 points for base deficit across all three species. Quantifying human post-traumatic shock based on base deficit and adjusting for Glasgow Coma Scale score, prothrombin time, Injury Severity Score and age is demonstrated to be superior to anatomic injury severity alone or in combination with Trauma and Injury Severity Score. The data examined in this review indicate that estimates of oxygen debt and its metabolic correlates should be included in studies of experimental shock and in the management of patients suffering from hemorrhagic shock.

Blood pressure changes induced by arterial blood withdrawal influence bold signal in anesthesized rats at 7 Tesla: implications for pharmacologic mri

Functional magnetic resonance imaging (fMRI) using the blood oxygenation level-dependent (BOLD) contrast is now increasingly applied for measuring drug effects on brain activity. A possible confound in pharmacologic fMRI (phMRI) is that the BOLD signal may be sensitive to systemic cardiovascular or respiratory parameters, which can themselves be modulated by a drug. To assess whether abrupt changes in arterial blood pressure (BP) as may be observed in phMRI experiments influence the BOLD signal, a hemorrhage model was studied in anesthesized rats at 7 T using spin-echo EPI. BP and BOLD signal time courses were found to be significantly correlated (P < 0.01). This effect was detected under the three different anesthetic regimens employed (isoflurane, halothane, and propofol). The regional pattern of BP-BOLD correlations was heterogeneous and may reflect vascular density. In physiological terms, a BOLD decrease during a decrease in BP may result from an increase in mostly venous cerebral blood volume (CBV) as an autoregulatory response to maintain cerebral blood flow (CBF) during decreased perfusion pressure. The observed influence of BP on BOLD may complicate qualitative and quantitative description of drug effects.

Hemodynamics and metabolic effects of fructose 1-6 diphosphate in ischemia and shock--experimental and clinical observations

Numerous interventions have been used to protect organ systems and cellular viability from the lethal injury accompanying hypoperfusion and ischemia. Some measures have been directed toward improving perfusion, while others have attempted to enhance the metabolic processes. Our work has focused for the most part on augmenting the anaerobic carbohydrate utilization in ischemic and hypoperfused tissues with fructose-1,6-diphosphate (FDP). Such an approach is based on the premise that exogenous FDP will restore the activity of glycolysis, which has been inhibited by acidosis, by intervening in the Embden-Meyerhoff pathway both as a metabolic regulator and as a high-energy substrate. We have tested this hypothesis in more than 1,000 animals subjected to shock or regional ischemia, and the results appear to confirm our presumption. In myocardial infarction, FDP improves hemodynamic parameters, attenuates ECG-proven ischemic injury and dysrhythmias, prevents ATP and creatine phosphate depletion from ischemic myocardium, reduces infarct size, and increases survival. In hemorrhagic, traumatic, and endotoxin shock, FDP improves hemodynamics, attenuates organ injury, and increases survival. Recently we demonstrated that FDP attenuates the reperfusion ischemic tissue injury by inhibiting the generation of oxygen free radicals by neutrophils. In normal volunteers, this agent increases carbohydrate utilization, while administration of a like amount of glucose produces no effect. In patients with myocardial infarction, FDP appears to have the same effect as that observed in the animal model. When this agent is administered to patients in traumatic, hemorrhagic, or septic shock, hemodynamic and pulmonary function are significantly improved. In patients with adult respiratory distress syndrome, similar beneficial effects have been observed with FDP administration.(ABSTRACT TRUNCATED AT 250 WORDS)

The effects of PNMT inhibitors upon cardiovascular changes induced by hemorrhage in the rat

Rapid bleeding in normotensive Sprague-Dawley rats produces a marked fall in arterial blood pressure and a profound decrease in heart rate. The bradycardia, which is abolished by vagotomy and partially antagonized by atropine, was significantly prolonged by pretreatment with SK&F 64139, a potent in vivo inhibitor of peripheral and central (CNS) phenylethanolamine N-methyltransferase (PNMT). This effect of the drug was accompanied by a prolonged hypotensive period and was not seen with SK&F 29661, a selective inhibitor of peripheral (adrenal) PNMT or with SK&F 72223, a structural analog of SK&F 64139 which has no effect on PNMT. These data suggest that the effects of SK&F 64139 are a result of inhibition of central PNMT and that epinephrine may function as a central neurotransmitter mediating cardiovascular responses to hemorrhage, at least under the conditions of these studies.