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Küchler J, Klaus S, Bahlmann L, Onken N, Keck A, Smith E, Gliemroth J, Ditz C. Cerebral effects of resuscitation with either epinephrine or vasopressin in an animal model of hemorrhagic shock. Eur J Trauma Emerg Surg 2020; 46:1451-1461. [PMID: 31127320 DOI: 10.1007/s00068-019-01158-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Accepted: 05/20/2019] [Indexed: 11/30/2022]
Abstract
PURPOSE The use of epinephrine (EN) or vasopressin (VP) in hemorrhagic shock is well established. Due to its specific neurovascular effects, VP might be superior in concern to brain tissue integrity. The aim of this study was to evaluate cerebral effects of either EN or VP resuscitation after hemorrhagic shock. METHODS After shock induction fourteen pigs were randomly assigned to two treatment groups. After 60 min of shock, resuscitation with either EN or VP was performed. Hemodynamics, arterial blood gases as well as cerebral perfusion pressure (CPP) and brain tissue oxygenation (PtiO2) were recorded. Interstitial lactate, pyruvate, glycerol and glutamate were assessed by cerebral and subcutaneous microdialysis. Treatment-related effects were compared using one-way ANOVA with post hoc Bonferroni adjustment (p < 0.05) for repeated measures. RESULTS Induction of hemorrhagic shock led to a significant (p < 0.05) decrease of mean arterial pressure (MAP), cardiac output (CO) and CPP. Administration of both VP and EN sufficiently restored MAP and CPP and maintained physiological PtiO2 levels. Brain tissue metabolism was not altered significantly during shock and subsequent treatment with VP or EN. Concerning the excess of glycerol and glutamate, we found a significant EN-related release in the subcutaneous tissue, while brain tissue values remained stable during EN treatment. VP treatment resulted in a non-significant increase of cerebral glycerol and glutamate. CONCLUSIONS Both vasopressors were effective in restoring hemodynamics and CPP and in maintaining brain oxygenation. With regards to the cerebral metabolism, we cannot support beneficial effects of VP in this model of hemorrhagic shock.
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Affiliation(s)
- Jan Küchler
- Department of Neurosurgery, University of Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany
| | - Stephan Klaus
- Department of Anesthesiology, Herz-Jesu-Krankenhaus Münster-Hiltrup, Münster, Germany
| | - Ludger Bahlmann
- Department of Anesthesiology, Klinikum Weser Egge, Höxter, Germany
| | - Nils Onken
- Department of Pediatrics, Klinikum Bremen-Mitte, Bremen, Germany
| | - Alexander Keck
- Department of Gynecology and Obstetrics, Klinikum Osnabrück, Osnabrück, Germany
| | - Emma Smith
- Department of Neurosurgery, University of Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany
| | - Jan Gliemroth
- Department of Neurosurgery, University of Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany
| | - Claudia Ditz
- Department of Neurosurgery, University of Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany.
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Ida KK, Otsuki DA, Sasaki ATC, Borges ES, Castro LUC, Sanches TR, Shimizu MHM, Andrade LC, Auler JOC, Dyson A, Smith KJ, Rocha Filho JA, Malbouisson LMS. Effects of terlipressin as early treatment for protection of brain in a model of haemorrhagic shock. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2015; 19:107. [PMID: 25888229 PMCID: PMC4373118 DOI: 10.1186/s13054-015-0825-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/02/2014] [Accepted: 02/19/2015] [Indexed: 01/01/2023]
Abstract
Introduction We investigated whether treatment with terlipressin during recovery from hypotension due to haemorrhagic shock (HS) is effective in restoring cerebral perfusion pressure (CPP) and brain tissue markers of water balance, oxidative stress and apoptosis. Methods In this randomised controlled study, animals undergoing HS (target mean arterial pressure (MAP) 40 mmHg for 30 minutes) were randomised to receive lactated Ringer’s solution (LR group; n =14; volume equal to three times the volume bled), terlipressin (TERLI group; n =14; 2-mg bolus), no treatment (HAEMO group; n =12) or sham (n =6). CPP, systemic haemodynamics (thermodilution technique) and blood gas analyses were registered at baseline, shock and 5, 30, 60 (T60), 90 and 120 minutes after treatment (T120). After the animals were killed, brain tissue samples were obtained to measure markers of water balance (aquaporin-4 (AQP4)), Na+-K+-2Cl− co-transporter (NKCC1)), oxidative stress (thiobarbituric acid reactive substances (TBARS) and manganese superoxide dismutase (MnSOD)) and apoptotic damage (Bcl-x and Bax). Results Despite the HS-induced decrease in cardiac output (CO) and hyperlactataemia, resuscitation with terlipressin recovered MAP and resulted in restoration of CPP and in cerebral protection expressed by normalisation of AQP4, NKCC1, TBARS and MnSOD expression and Bcl-x/Bax ratio at T60 and T120 compared with sham animals. In the LR group, CO and blood lactate levels were recovered, but the CPP and MAP were significantly decreased and TBARS levels and AQP4, NKCC1 and MnSOD expression and Bcl-x/Bax ratio were significantly increased at T60 and T120 compared with the sham group. Conclusions During recovery from HS-induced hypotension, terlipressin was effective in normalising CPP and cerebral markers of water balance, oxidative damage and apoptosis. The role of this pressor agent on brain perfusion in HS requires further investigation.
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Affiliation(s)
- Keila Kazue Ida
- Laboratório de Investigação Médica (LIM-08), Disciplina de Anestesiologia, Faculdade de Medicina, Universidade de São Paulo, Avenida Doutor Arnaldo, 455, 2° andar, sala 2120, Cerqueira César, São Paulo, SP, 01246-903, Brazil. .,Department of Neuroinflammation, Institute of Neurology, University College London (UCL), 1 Wakefield Street, 2nd floor, WC1N 1PJ, London, UK.
| | - Denise Aya Otsuki
- Laboratório de Investigação Médica (LIM-08), Disciplina de Anestesiologia, Faculdade de Medicina, Universidade de São Paulo, Avenida Doutor Arnaldo, 455, 2° andar, sala 2120, Cerqueira César, São Paulo, SP, 01246-903, Brazil.
| | - Adolfo Toshiro Cotarelli Sasaki
- Laboratório de Investigação Médica (LIM-08), Disciplina de Anestesiologia, Faculdade de Medicina, Universidade de São Paulo, Avenida Doutor Arnaldo, 455, 2° andar, sala 2120, Cerqueira César, São Paulo, SP, 01246-903, Brazil.
| | - Emilyn Silva Borges
- Laboratório de Investigação Médica (LIM-08), Disciplina de Anestesiologia, Faculdade de Medicina, Universidade de São Paulo, Avenida Doutor Arnaldo, 455, 2° andar, sala 2120, Cerqueira César, São Paulo, SP, 01246-903, Brazil.
| | - Letícia Urbano Cardoso Castro
- Disciplina de Nefrologia, Faculdade de Medicina, Universidade de São Paulo (LIM-12 HC-FMUSP), Avenida Doutor Arnaldo, 455, 3rd floor, Cerqueira César, São Paulo, SP, 01246-903, Brazil.
| | - Talita Rojas Sanches
- Disciplina de Nefrologia, Faculdade de Medicina, Universidade de São Paulo (LIM-12 HC-FMUSP), Avenida Doutor Arnaldo, 455, 3rd floor, Cerqueira César, São Paulo, SP, 01246-903, Brazil.
| | - Maria-Heloisa Massola Shimizu
- Disciplina de Nefrologia, Faculdade de Medicina, Universidade de São Paulo (LIM-12 HC-FMUSP), Avenida Doutor Arnaldo, 455, 3rd floor, Cerqueira César, São Paulo, SP, 01246-903, Brazil.
| | - Lúcia Conceição Andrade
- Disciplina de Nefrologia, Faculdade de Medicina, Universidade de São Paulo (LIM-12 HC-FMUSP), Avenida Doutor Arnaldo, 455, 3rd floor, Cerqueira César, São Paulo, SP, 01246-903, Brazil.
| | - José-Otávio Costa Auler
- Laboratório de Investigação Médica (LIM-08), Disciplina de Anestesiologia, Faculdade de Medicina, Universidade de São Paulo, Avenida Doutor Arnaldo, 455, 2° andar, sala 2120, Cerqueira César, São Paulo, SP, 01246-903, Brazil.
| | - Alex Dyson
- Division of Medicine, University College London (UCL), Gower Street, WC1E 6BT, London, UK.
| | - Kenneth John Smith
- Department of Neuroinflammation, Institute of Neurology, University College London (UCL), 1 Wakefield Street, 2nd floor, WC1N 1PJ, London, UK.
| | - Joel Avancini Rocha Filho
- Divisão de Anestesiologia, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), Av. Dr. Enéas de Carvalho Aguiar,155, 8th floor, 05403-000, São Paulo, SP, Brazil.
| | - Luiz-Marcelo Sá Malbouisson
- Laboratório de Investigação Médica (LIM-08), Disciplina de Anestesiologia, Faculdade de Medicina, Universidade de São Paulo, Avenida Doutor Arnaldo, 455, 2° andar, sala 2120, Cerqueira César, São Paulo, SP, 01246-903, Brazil.
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