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Behem CR, Haunschild J, Pinnschmidt HO, Gaeth C, Graessler MF, Trepte CJC, Etz CD, Debus ES, Wipper SH. Effects of fluids vs. vasopressors on spinal cord microperfusion in hemorrhagic shock induced ischemia/reperfusion. Microvasc Res 2022; 143:104383. [PMID: 35605693 DOI: 10.1016/j.mvr.2022.104383] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 05/13/2022] [Accepted: 05/17/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Spinal cord injury induced by ischemia/reperfusion is a devastating complication of aortic repair. Despite developments for prevention and treatment of spinal cord injury, incidence is still considerably high majorly impacting patient outcome. Microcirculation is paramount for tissue perfusion and oxygen supply and often dissociated from macrohemodynamic parameters used to guide resuscitation. Effects of fluids vs. vasopressors in the setting of hemodynamic resuscitation on spinal cord microperfusion are unknown. Aim of this study was to compare the effects of vasopressor and fluid resuscitation on spinal cord microperfusion in a translational acute pig model of hemorrhagic shock induced ischemia/reperfusion injury. METHODS We designed this study as prospective randomized explorative large animal study. We induced hemorrhagic shock in 20 pigs as a model of global ischemia/reperfusion injury. We randomized animals to receive either fluid or vasopressor resuscitation. We measured spinal cord microperfusion using fluorescent microspheres as well as laser-Doppler probes. We monitored and analyzed macrohemodynamic parameters and cerebrospinal fluid pressure. RESULTS Spinal cord microperfusion decreased following hemorrhagic shock induced ischemia/reperfusion injury. Both fluids and vasopressors sufficiently restored spinal cord microperfusion. There were no important changes between groups (percentage changes compared to baseline: fluids 14.0 (0.31-27.6) vs. vasopressors 24.3 (8.12-40.4), p = .340). However, cerebrospinal fluid pressure was higher in animals receiving fluid resuscitation (percentage changes compared to baseline: fluids 27.7 (12.6-42.8) vs. vasopressors -5.56 ((-19.8)-8.72), p = .003). Microcirculatory resuscitation was in line with improvements of macrohemodynamic parameters. CONCLUSIONS Both, fluids and vasopressors, equally restored spinal cord microperfusion in a porcine acute model of hemorrhagic shock induced ischemia/reperfusion injury. However, significant differences in cerebrospinal fluid pressure following resuscitation were present. Future studies should evaluate these effects in perfusion disruption induced ischemia/reperfusion conditions of microcirculatory deterioration.
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Affiliation(s)
- Christoph R Behem
- Department of Anesthesiology, Center of Anesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - Josephina Haunschild
- University Department for Cardiac Surgery, Heart Center Leipzig, Leipzig, Germany
| | - Hans O Pinnschmidt
- Department of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Catharina Gaeth
- Department of Vascular Medicine, University Heart and Vascular Center Hamburg (UHZ), Hamburg, Germany
| | - Michael F Graessler
- Department of Anesthesiology, Center of Anesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Constantin J C Trepte
- Department of Anesthesiology, Center of Anesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christian D Etz
- University Department for Cardiac Surgery, Heart Center Leipzig, Leipzig, Germany
| | - E Sebastian Debus
- Department of Vascular Medicine, University Heart and Vascular Center Hamburg (UHZ), Hamburg, Germany
| | - Sabine H Wipper
- Department of Vascular Medicine, University Heart and Vascular Center Hamburg (UHZ), Hamburg, Germany
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Libert N, Laemmel E, Harrois A, Laitselart P, Bergis B, Isnard P, Terzi F, Decante B, Mercier O, Vicaut E, Duranteau J. Renal Microcirculation and Function in a Pig Model of Hemorrhagic Shock Resuscitation with Norepinephrine. Am J Respir Crit Care Med 2022; 206:34-43. [PMID: 35394403 DOI: 10.1164/rccm.202109-2120oc] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
RATIONALE Norepinephrine (NE) is commonly used in combination with fluid during resuscitation of hemorrhagic shock, however its impact on kidney microcirculation, oxygenation and function is still unknown in this setting. OBJECTIVES During hemorrhagic shock resuscitation, does a combination of fluid and norepinephrine affect kidney oxygenation tension, kidney microcirculatory perfusion and 48-hour kidney function, as compared to fluid alone? METHODS Hemorrhagic shock was induced in 24 pigs and 8 pigs were included as sham. Resuscitation of hemorrhagic shock was performed, using a closed-loop device, either by fluid alone (0.9% NaCl, Fluid group) or associated with the administration of NE at two doses (moderate dose: mean rate of 0.64 µg.kg-1.min-1 and high dose: mean rate of 1.57 µg.kg-1.min-1) in order to obtain SAP (systolic arterial pressure) target of 80-90 mmHg. Resuscitation was followed by transfusion of the withdrawn blood. MEASUREMENTS AND MAIN RESULTS The amount of fluid required to reach SAP target was lower in NE groups than in Fluid group with subsequent less hemodilution. Norepinephrine restored kidney microcirculation, oxygenation, and function in a manner comparable to that achieved with fluid resuscitation alone. There were no histological differences among animals resuscitated with Fluid or with NE. CONCLUSION In pigs with hemorrhagic shock, resuscitation with a combination of NE and fluid restored kidney microcirculation and oxygenation, as well as renal function, in a manner comparable to fluid resuscitation alone and without differences between the two NE doses. NE administration led to a fluid volume sparing effect with subsequently less hemodilution.
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Affiliation(s)
- Nicolas Libert
- Hôpital d'instruction des armées Percy, Département d'anesthésie réanimation, Clamart, France.,Université Paris 7 Denis Diderot, 555089, Laboratoire d'Étude de la Microcirculation, UMR 942, Paris, France
| | - Elisabeth Laemmel
- Université Paris 7 Denis Diderot, 555089, Laboratoire d'Étude de la Microcirculation, UMR 942, Paris, France
| | - Anatole Harrois
- Hopital Bicetre, 41664, Anesthesiology and surgical intensive care, Le Kremlin-Bicetre, France.,Université Paris 7 Denis Diderot, 555089, Laboratoire d'Étude de la Microcirculation, UMR 942, Paris, France
| | - Philippe Laitselart
- Hôpital d'instruction des armées Percy, Département d'anesthésie réanimation, Clamart, France.,Université Paris 7 Denis Diderot, 555089, Laboratoire d'Étude de la Microcirculation, UMR 942, Paris, France
| | - Benjamin Bergis
- Hopital Bicetre, 41664, Anesthesiology and surgical intensive care, Le Kremlin-Bicetre, France.,Université Paris 7 Denis Diderot, 555089, Laboratoire d'Étude de la Microcirculation, UMR 942, Paris, France
| | - Pierre Isnard
- Hopital Necker-Enfants Malades, 246596, Anatomy and Cytology Pathology, Paris, France
| | - Fabiola Terzi
- INSERM U1151, 554251, CNRS UMR 8253, Institut Necker Enfants Malades, Département , Paris, France
| | - Benoit Decante
- Hôpital Marie Lannelongue , Unité de recherche et d'innovation, Le Plessis Robinson, France
| | - Olaf Mercier
- Université Paris-Sud Faculté de Médecine, 89691, École de médecine, Le Kremlin-Bicetre, France.,INSERM UMR_S999, 130034, Département de chirurgie thoracique et vasculaire et transplantation cœur-poumon, DHU Thorax Innovation, LabEx LERMIT, Hôpital Marie Lannelongue, Le Plessis Robinson, France
| | - Eric Vicaut
- Assistance Publique - Hopitaux de Paris, 26930, Paris, France.,Université Paris 7 Denis Diderot, 555089, Laboratoire d'Étude de la Microcirculation, UMR 942, Paris, France
| | - Jacques Duranteau
- Bicêtre University Hospital, Anesthesia and Intensive Care Department, Le Kremlin-Bicêtre, France.,Université Paris 7 Denis Diderot, 555089, Laboratoire d'Étude de la Microcirculation, UMR 942, Paris, France;
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