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Chevala NT, Kumar L, Veetilvalappil V, Mathew AJ, Paonam B, Mohan G, Shastry S, Balasubramanian K, Rao CM. Nanoporous and nano thickness film-forming bioactive composition for biomedical applications. Sci Rep 2022; 12:8198. [PMID: 35581396 PMCID: PMC9114407 DOI: 10.1038/s41598-022-12280-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Accepted: 04/25/2022] [Indexed: 11/09/2022] Open
Abstract
Unmanageable bleeding is one of the significant causes of mortality. Attaining rapid hemostasis ensures subject survivability as a first aid during combats, road accidents, surgeries that reduce mortality. Nanoporous fibers reinforced composite scaffold (NFRCS) developed by a simple hemostatic film-forming composition (HFFC) (as a continuous phase) can trigger and intensify hemostasis. NFRCS developed was based on the dragonfly wing structure's structural design. Dragonfly wing structure consists of cross-veins and longitudinal wing veins inter-connected with wing membrane to maintain the microstructural integrity. The HFFC uniformly surface coats the fibers with nano thickness film and interconnects the randomly distributed cotton gauge (Ct) (dispersed phase), resulting in the formation of a nanoporous structure. Integrating continuous and dispersed phases reduce the product cost by ten times that of marketed products. The modified NFRCS (tampon or wrist band) can be used for various biomedical applications. The in vivo studies conclude that the developed Cp NFRCS triggers and intensifies the coagulation process at the application site. The NFRCS could regulate the microenvironment and act at the cellular level due to its nanoporous structure, which resulted in better wound healing in the excision wound model.
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Affiliation(s)
- Naga Thirumalesh Chevala
- Department of Pharmaceutics, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
| | - Lalit Kumar
- Department of Pharmaceutics, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India.
| | - Vimal Veetilvalappil
- Department of Biotechnology, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
| | - Aranjani Jesil Mathew
- Department of Biotechnology, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
| | - Bemma Paonam
- Department of Immunohematology and Blood Transfusion, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
| | - Ganesh Mohan
- Department of Immunohematology and Blood Transfusion, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
| | - Shamee Shastry
- Department of Immunohematology and Blood Transfusion, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
| | | | - C Mallikarjuna Rao
- Department of Pharmacology, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
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A review of treatments for non-compressible torso hemorrhage (NCTH) and internal bleeding. Biomaterials 2022; 283:121432. [DOI: 10.1016/j.biomaterials.2022.121432] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 01/26/2022] [Accepted: 02/17/2022] [Indexed: 12/12/2022]
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Michimoto K, Ashida H, Higuchi T, Kano R, Hasumi J, Suzuki T, Ishida K, Hirayama H, Ohta A. Hemorrhagic Complication in Surgical Resection for Massive Plexiform Neurofibroma in Body Trunk: The Flow-Void Sign as a Predictor and Preoperative Embolization as Prevention. World J Surg 2021; 45:3603-3608. [PMID: 34415403 DOI: 10.1007/s00268-021-06299-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/07/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Plexiform neurofibromas (PNs) are highly vascularized and potentially malignant tumors. Surgical resection of a PN can be complicated by perioperative hemorrhagic events (PHE), including excessive intraoperative blood loss and postoperative hematoma at the surgical site. This study aimed to evaluate the predictive factors of PHE and the usefulness of preoperative embolization for PN. MATERIALS AND METHODS Consecutive surgical resections of 24 massive PNs in the body trunk with a maximum diameter > 5 cm in 22 patients between January 2015 and December 2020 were reviewed. Patient demographics, laboratory analyses, MRI findings, preoperative transcatheter arterial embolization (TAE), and pathological findings were evaluated between PNs with and without PHE, which consists of intraoperative blood loss over 15% of their estimated total blood volume and/or postoperative hematoma requiring surgical intervention or blood transfusion. RESULTS PHE was observed in 7 out of 24 PNs (29.2%), with 5 events of excessive intraoperative bleeding and 2 postoperative hematomas. The PHE group (n = 7) showed a significantly higher flow-void effect inside the tumor on preoperative MRI than the non-PHE group (n = 17) (P = 0.0186). Preoperative TAE was not associated with PHE occurrence for the 24 PNs; however, it significantly reduced the PHE risk by 12 PNs with a flow-void sign (P = 0.00126). Other characteristics showed no significant differences between groups. CONCLUSION The flow-void sign on MRI can be the only predictive factor of PHE in surgical resection for massive PNs in the body trunk. Preoperative TAE can reduce the PHE risk for PNs with a flow-void sign.
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Affiliation(s)
- Kenkichi Michimoto
- Department of Radiology, The Jikei University School of Medicine, 3-19-18, Nishishimbashi, Minato-ku, Tokyo, 105-8471, Japan.
| | - Hirokazu Ashida
- Department of Radiology, The Jikei University School of Medicine, 3-19-18, Nishishimbashi, Minato-ku, Tokyo, 105-8471, Japan
| | - Takahiro Higuchi
- Department of Radiology, The Jikei University School of Medicine, 3-19-18, Nishishimbashi, Minato-ku, Tokyo, 105-8471, Japan
| | - Rui Kano
- Department of Radiology, The Jikei University School of Medicine, 3-19-18, Nishishimbashi, Minato-ku, Tokyo, 105-8471, Japan
| | - Jun Hasumi
- Department of Radiology, The Jikei University School of Medicine, 3-19-18, Nishishimbashi, Minato-ku, Tokyo, 105-8471, Japan
| | - Takayuki Suzuki
- Department of Radiology, The Jikei University School of Medicine, 3-19-18, Nishishimbashi, Minato-ku, Tokyo, 105-8471, Japan
| | - Katsuhiro Ishida
- Department of Plastic and Reconstructive Surgery, The Jikei University School of Medicine, 3-19-18, Nishishimbashi, Minato-ku, Tokyo, 105-8471, Japan
| | - Haruyuki Hirayama
- Department of Plastic and Reconstructive Surgery, The Jikei University School of Medicine, 3-19-18, Nishishimbashi, Minato-ku, Tokyo, 105-8471, Japan
| | - Arihito Ohta
- Department of Dermatology, The Jikei University School of Medicine, 3-19-18, Nishishimbashi, Minato-ku, Tokyo, 105-8471, Japan
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Convertino VA, Koons NJ, Suresh MR. Physiology of Human Hemorrhage and Compensation. Compr Physiol 2021; 11:1531-1574. [PMID: 33577122 DOI: 10.1002/cphy.c200016] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Hemorrhage is a leading cause of death following traumatic injuries in the United States. Much of the previous work in assessing the physiology and pathophysiology underlying blood loss has focused on descriptive measures of hemodynamic responses such as blood pressure, cardiac output, stroke volume, heart rate, and vascular resistance as indicators of changes in organ perfusion. More recent work has shifted the focus toward understanding mechanisms of compensation for reduced systemic delivery and cellular utilization of oxygen as a more comprehensive approach to understanding the complex physiologic changes that occur following and during blood loss. In this article, we begin with applying dimensional analysis for comparison of animal models, and progress to descriptions of various physiological consequences of hemorrhage. We then introduce the complementary side of compensation by detailing the complexity and integration of various compensatory mechanisms that are activated from the initiation of hemorrhage and serve to maintain adequate vital organ perfusion and hemodynamic stability in the scenario of reduced systemic delivery of oxygen until the onset of hemodynamic decompensation. New data are introduced that challenge legacy concepts related to mechanisms that underlie baroreflex functions and provide novel insights into the measurement of the integrated response of compensation to central hypovolemia known as the compensatory reserve. The impact of demographic and environmental factors on tolerance to hemorrhage is also reviewed. Finally, we describe how understanding the physiology of compensation can be translated to applications for early assessment of the clinical status and accurate triage of hypovolemic and hypotensive patients. © 2021 American Physiological Society. Compr Physiol 11:1531-1574, 2021.
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Affiliation(s)
- Victor A Convertino
- Battlefield Healthy & Trauma Center for Human Integrative Physiology, United States Army Institute of Surgical Research, JBSA San Antonio, Texas, USA
| | - Natalie J Koons
- Battlefield Healthy & Trauma Center for Human Integrative Physiology, United States Army Institute of Surgical Research, JBSA San Antonio, Texas, USA
| | - Mithun R Suresh
- Battlefield Healthy & Trauma Center for Human Integrative Physiology, United States Army Institute of Surgical Research, JBSA San Antonio, Texas, USA
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Ting WT, Chang RW, Wang CH, Chen YS, Lee JJ. Comparison of the trometamol-balanced solution with two other crystalloid solutions for fluid resuscitation of a rat hemorrhagic model. J Vet Sci 2020; 21:e6. [PMID: 31940685 PMCID: PMC7000892 DOI: 10.4142/jvs.2020.21.e6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2019] [Revised: 09/30/2019] [Accepted: 10/21/2019] [Indexed: 12/31/2022] Open
Abstract
Currently, the optimal resuscitation fluid remains debatable. Therefore, in the present study, we designed a trometamol-balanced solution (TBS) for use as a resuscitation fluid for hemorrhagic shock. Hemorrhagic shock was induced in 18 male Wistar-Kyoto rats, which were assigned to normal saline (NS), Ringer's solution (RS), and TBS groups. During the hemorrhagic state, their hemodynamic parameters were recorded using an Abbott i-STAT analyzer with the CG4+ cartridge (for pH, pressure of carbon dioxide, pressure of oxygen, total carbon dioxide, bicarbonate, base excess, oxygen saturation, and lactate), the CG6+ cartridge (for sodium, potassium, chloride, blood glucose, blood urea nitrogen, hematocrit, and hemoglobin), and enzyme-linked immunosorbent assay kits (calcium, magnesium, creatinine, aspartate aminotransferase, alanine aminotransferase, bilirubin, and albumin). Similar trends were found for the parameters of biochemistries, electrolytes, and blood gas, and they revealed no significant changes after blood withdrawal-induced hemorrhagic shock. However, the TBS group showed more effective ability to correct metabolic acidosis than the NS and RS groups. TBS was a feasible and safe resuscitation solution in this study and may be an alternative to NS and RS for resuscitation in hemorrhagic shock patients without liver damage.
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Affiliation(s)
- Wen Ting Ting
- Department and Graduate Institute of Veterinary Medicine, School of Veterinary Medicine, National Taiwan University, Taipei 10617, Taiwan.,Cardiovascular Surgery, Department of Surgery, National Taiwan University Hospital, National Taiwan University, Taipei 10002, Taiwan.,Graduate Institute of Veterinary Clinical Sciences, School of Veterinary Medicine, National Taiwan University, Taipei 10672, Taiwan
| | - Ru Wen Chang
- Cardiovascular Surgery, Department of Surgery, National Taiwan University Hospital, National Taiwan University, Taipei 10002, Taiwan
| | - Chih Hsien Wang
- Cardiovascular Surgery, Department of Surgery, National Taiwan University Hospital, National Taiwan University, Taipei 10002, Taiwan
| | - Yih Sharng Chen
- Cardiovascular Surgery, Department of Surgery, National Taiwan University Hospital, National Taiwan University, Taipei 10002, Taiwan.
| | - Jih Jong Lee
- Department and Graduate Institute of Veterinary Medicine, School of Veterinary Medicine, National Taiwan University, Taipei 10617, Taiwan.,Graduate Institute of Veterinary Clinical Sciences, School of Veterinary Medicine, National Taiwan University, Taipei 10672, Taiwan.,Animal Cancer Treatment Center, National Taiwan University Veterinary Hospital, Taipei 10672, Taiwan.
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Gao Q, Zhang L, Wang G, Xu D, Feng M, Wang F, Wei Q, Liu X, Guo F. A novel neuroimaging assessment of predictive risk factors associated with intraoperative massive hemorrhage in intracranial solid hemangioblastoma. Quant Imaging Med Surg 2019; 9:1781-1791. [PMID: 31867232 DOI: 10.21037/qims.2019.09.05] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background A solid hemangioblastoma (SH) is a benign and highly vascularized tumor. Microsurgical treatment of SH is still challenging due to excessive intraoperative bleeding. Methods Sixty-six consecutive patients with SH were retrospectively analyzed. The volume of intraoperative blood loss (IBL) and the features detected by magnetic resonance imaging (MRI) were evaluated by a neurosurgeon and multiple neuroradiologists. Results Four striking MRI features-peritumoral edema, the flow-void effect, large draining veins, and a visible feeding artery-were related to excessive IBL. Regarding the weighted values of these risk factors, the flow-void effect was the factor most significantly correlated with IBL (P<0.01, R=0.418). The feeding artery also contributed substantially to excessive IBL (P<0.05, R=0.412). The next most influential factor was the presence of large draining veins (P<0.05, R=0.350), followed by peritumoral edema (P<0.05, R=0.308). The four major risk factors-the flow-void effect, feeding arteries, large draining veins, and peritumoral edema-were assigned point values of 3, 3, 2, and 1, respectively, for a maximum total score of 9 points. A higher total score indicates that a higher volume of bleeding is more likely to occur during surgery. Conclusions This study reports the potential neuroimaging-based risk factors leading to abundant IBL in SH by neuroimaging assessment. The study proposes a novel scoring system to predict IBL, potentially decreasing the risk involved in the surgical treatment of SH.
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Affiliation(s)
- Qiang Gao
- Department of Neurosurgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
| | - Lan Zhang
- Department of MRI, The First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou 450003, China
| | - Guoqing Wang
- Department of Neurosurgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
| | - Dingkang Xu
- Department of Neurosurgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
| | - Mengzhao Feng
- Department of Neurosurgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
| | - Fang Wang
- Department of Neurosurgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
| | - Qingjie Wei
- Department of Neurosurgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
| | - Xianzhi Liu
- Department of Neurosurgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
| | - Fuyou Guo
- Department of Neurosurgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
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Soedjono G, Harlina E, Pudjiadi AH, Purba MS, Widodo SJ. Evaluation of ventilator on lung profile of piglets ( Sus scrofa) in hypovolemic shock treated with hypervolemic crystalloid resuscitation. Vet World 2019; 12:565-571. [PMID: 31190712 PMCID: PMC6515836 DOI: 10.14202/vetworld.2019.565-571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Accepted: 02/20/2019] [Indexed: 12/02/2022] Open
Abstract
AIM This study was conducted to assess the effect of ventilators on the lung profile of piglets in the hypovolemic shock before and after the excessive resuscitation of the crystalloid fluid. MATERIALS AND METHODS Five male piglets were used in this study as the models of shock, and there are four phases of treatment: Stabilization, shock of bleeding, normovolemic resuscitation, and hypervolemic resuscitation. The application of mechanical ventilation to patients who suspected of having lung injury may worsen the patient's conditions. The purpose of this study was to set the ventilator with the set of positive end-expiratory pressure (PEEP) of 5 cm H2O, thefraction of inspired oxygen (FiO2) of 0.5, and the inspiration: expiration (I: E) ratio of 1:2, which was applied from the stabilization phase. The shock induction was performed by removing the blood until the mean arterial pressure decreasing by 20% from the stabilization. The solution of NaCl 0.9% was used for the normovolemic and hypervolemic resuscitation. The parameter of observation consisted of extravascular lung water index (EVLWI) and pulmonary vascular permeability index (PVPI) on pulse contour cardiac output 2 and exhaled tidal volume (VTE), peak inspiratory pressure (PIP), and respiratory rate (RR) on ventilators. RESULTS EVLWI does not indicate pulmonary edema. A significant decrease in VTE without any significant alterations in EVLWI, PIP, and RR has indicated the shallow breathing in the shock condition. Therefore, the PVPI parameter cannot be used as a parameter for capillary permeability since its formulation does not reinforce the results of data in the shock condition. The set of the ventilator may prevent the increase of EVLWI, and the uses of ventilators do not worsen the patient's conditions during the crystalloid resuscitation. CONCLUSION The use of mechanical ventilator as the support does not worsen the hypovolemic condition and is safe to use as long as the lung profile is not indicated to have lung injury.
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Affiliation(s)
- Gunanti Soedjono
- Department of Veterinary Clinic Reproduction and Pathology, Division of Veterinary Surgery and Radiology, Faculty of Veterinary Medicine, Bogor Agricultural University, Bogor, Indonesia
- Veterinary Paramedic Study Program, Directorate of Diploma Programs, Bogor Agricultural University, Bogor, Indonesia
| | - Eva Harlina
- Department of Veterinary Clinic Reproduction and Pathology, Division of Veterinary Pathology, Faculty of Veterinary Medicine, Bogor Agricultural University, Bogor, Indonesia
| | - Antonius H. Pudjiadi
- Department of Pediatric, Faculty of Medicine, University of Indonesia, Depok, Jawa Barat, Indonesia
| | - Melpa Susanti Purba
- Department of Veterinary Clinic Reproduction and Pathology, Division of Veterinary Surgery and Radiology, Faculty of Veterinary Medicine, Bogor Agricultural University, Bogor, Indonesia
| | - Setyo Jatimahardhiko Widodo
- Department of Veterinary Clinic Reproduction and Pathology, Division of Veterinary Surgery and Radiology, Faculty of Veterinary Medicine, Bogor Agricultural University, Bogor, Indonesia
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Shinta DW, Khotib J, Rahardjo E, Rahmadi M, Suprapti B. THE USE OF HYDROXYETHYL STARCH 200/0,5 AS PLASMA SUBTITUTES IS SAFE IN HYPOVOLEMIC PATIENTS AS INDICATED IN CHANGES OF N-ACETYL--GLUCOSAMINIDASE AND CREATININ SERUM PARAMETERS. FOLIA MEDICA INDONESIANA 2016. [DOI: 10.20473/fmi.v51i4.2852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Hydroxyethyl Starch (HES) is a compound that improves intravascular volume effectively and rapidly without causing tissue edema. However, HES also has renal safety profile which is still being debated. Based on clinical experience in Dr. Soetomo Hospital, the frequency of acute renal failure following HES 200/0.5 administration at a dose of less than 20 ml/kg (maximum dose) is very rare. The purpose of this study was to evaluate the effect of HES 200/0.5 at a dose of less than 20 ml/kg in patients undergoing surgery. N-acetyl-b-D-Glucosaminidase (NAG) per urine creatinine ratio and creatinine serum were used as main parameter to assess renal injury. This research was observational and prospective design in patients undergoing elective surgery at Gedung Bedah Pusat Terpadu, Dr. Soetomo Hospital, who requiring resuscitation therapy with HES 200/0.5 and met the inclusion and exclusion criteria. NAG was measured prior to surgery and 12 hours after administration of fluid therapy, while creatinine serum was observed before surgery and 48 hours after resuscitation. This study was conducted for three months, and obtained 50 subjects divided into 2 groups, crystalloid group and HES 200/0.5 group. Demographic and baseline characteristics did not differ between groups, except the total bleeding volume. Total bleeding in HES 200/0.5group was higher than crystalloid group (p <0.0001). The mean volume of fluid received in HES 200/0.5 group was 2042.0 ± 673.9 mL, higher when compared with that of crystalloid group (910.0 ± 592.0 ml). Doses of HES 200/0.5 received was 8.31 ± 4.86 ml/kg. Measurement of the of NAG/creatinine ratio and creatinine serum showed significant increase in both groups, but still within the normal range. In addition, the value of these two parameters did not differ between groups. In conclusion, HES 200/0.5 in a dose of less than 20 ml/kg is safe to use in patients who suffered from hypovolemic hemorrhage, without prior history of renal impairment.
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Sun N, Luo W, Li LZ, Luo Q. Monitoring hemodynamic and metabolic alterations during severe hemorrhagic shock in rat brains. Acad Radiol 2014; 21:175-84. [PMID: 24439331 DOI: 10.1016/j.acra.2013.11.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2013] [Revised: 11/26/2013] [Accepted: 11/26/2013] [Indexed: 10/25/2022]
Abstract
RATIONALE AND OBJECTIVES Our long-term goals are to identify imaging biomarkers for hemorrhagic shock and to understand how the preservation of cerebral microcirculation works. We also seek to understand how the damage occurs to the cerebral hemodynamics and the mitochondrial metabolism during severe hemorrhagic shock. MATERIALS AND METHODS We used a multimodal cerebral cortex optical imaging system to obtain 4-hour observations of cerebral hemodynamic and metabolic alterations in exposed rat cortexes during severe hemorrhagic shock. We monitored the mean arterial pressure, heart rate, cerebral blood flow (CBF), functional vascular density (FVD), vascular perfusion and diameter, blood oxygenation, and mitochondrial reduced nicotinamide adenine dinucleotide (NADH) signals. RESULTS During the rapid bleeding and compensatory stage, cerebral parenchymal circulation was protected by inhibiting the perfusion of dural vessels. During the compensatory stage, although the brain parenchymal CBF and FVD decreased rapidly, the NADH signal did not show a significant increase. During the decompensatory stage, FVD and CBF maintained the same low level and the NADH signal remained unchanged. However, the NADH signal showed a significant increase after the rapid blood infusion. FVD and CBF rebounded to the baseline after the resuscitation and then declined again. CONCLUSIONS We present for the first time simultaneous imaging of cerebral hemodynamics and NADH signals in vivo during the process of hemorrhagic shock. This novel multimodal method demonstrated clearly that severe hemorrhagic shock imparts irreversible tissue damage that is not compensated by the autoregulatory mechanism. Hemodynamic and metabolic signatures including CBF, FVD, and NADH may be further developed to provide sensitive biomarkers for stage transitions in hemorrhagic shock.
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Abstract
Early recognition and treatment of pediatric shock, regardless of cause, decreases mortality and improves outcome. In addition to the conventional parameters (eg, heart rate, systolic blood pressure, urine output, and central venous pressure), biomarkers and noninvasive methods of measuring cardiac output are available to monitor and treat shock. This article emphasizes how fluid resuscitation is the cornerstone of shock resuscitation, although the choice and amount of fluid may vary based on the cause of shock. Other emerging treatments for shock (ie, temperature control, extracorporeal membrane oxygenation/ventricular assist devices) are also discussed.
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Affiliation(s)
- Haifa Mtaweh
- Departments of Critical Care Medicine and Pediatrics, University of Pittsburgh School of Medicine and Children’s Hospital of Pittsburgh; Pittsburgh, PA
| | - Erin V. Trakas
- Departments of Critical Care Medicine and Pediatrics, University of Pittsburgh School of Medicine and Children’s Hospital of Pittsburgh; Pittsburgh, PA
| | - Erik Su
- Department of Anesthesia and Critical Care Medicine, Johns Hopkins Hospital; 1800 Orleans Street, Baltimore, MD 21287
| | - Joseph A. Carcillo
- Departments of Critical Care Medicine and Pediatrics, University of Pittsburgh School of Medicine and Children’s Hospital of Pittsburgh; Pittsburgh, PA
| | - Rajesh K. Aneja
- Departments of Critical Care Medicine and Pediatrics, University of Pittsburgh School of Medicine and Children’s Hospital of Pittsburgh; Pittsburgh, PA
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Xu H, Han LC, Gao W, Sun XX, Zhou Y, Meng XZ, Zhang H, Xu LX. Therapeutic Effects of Intravenous Infusion of Hyperoxygenated Solution on Acute Haemorrhagic Shock in Rabbits. J Int Med Res 2011; 39:1843-51. [DOI: 10.1177/147323001103900527] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Tissue anoxia is the main mechanism of the shock reaction. Here, the effect of hyperoxygenated solution (HOS) on acute haemorrhagic shock was studied in rabbits. At 60 min after shock, rabbits were infused intravenously with hyperoxygenated solution at 10 (HOS1 group) or 20 ml/kg (HOS2 group) or with Ringer's solution at 10 ml/kg (RS group). Compared with values before shock, values after shock were lower for mean arterial pressure (MAP), more negative for base excess (BE) and higher for blood lactate (BL) and blood viscosity. After infusion, MAP declined more slowly in the HOS1 and HOS2 groups than in the RS group. At 30 and 60 min after infusion, arterial partial pressure of oxygen (PaO2) and oxygen saturation (SaO2) were higher and BE was less negative in the HOS1 and HOS2 groups than in the RS group, BL was lower in the HOS1 and HOS2 groups than in the RS group, and PaO2 and SaO2 were higher in the HOS2 group than in the HOS1 group. It was concluded that HOS infusion can rectify changes in vital signs more effectively than Ringer's solution after acute haemorrhagic shock in rabbits.
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Affiliation(s)
- H Xu
- Department of Anaesthesiology, School of Stomatology, Fourth Military Medical University, Xi'an, Shaanxi Province, China
| | - LC Han
- Department of Anaesthesiology, Shaanxi Provincial Tumour Hospital, Xi'an, Shaanxi Province, China
| | - W Gao
- Department of Anaesthesiology, School of Stomatology, Fourth Military Medical University, Xi'an, Shaanxi Province, China
| | - XX Sun
- Department of Anaesthesiology, School of Stomatology, Fourth Military Medical University, Xi'an, Shaanxi Province, China
| | - Y Zhou
- Department of Anaesthesiology, School of Stomatology, Fourth Military Medical University, Xi'an, Shaanxi Province, China
| | - XZ Meng
- Department of Anaesthesiology, School of Stomatology, Fourth Military Medical University, Xi'an, Shaanxi Province, China
| | - H Zhang
- Department of Anaesthesiology, School of Stomatology, Fourth Military Medical University, Xi'an, Shaanxi Province, China
| | - LX Xu
- Department of Anaesthesiology, School of Stomatology, Fourth Military Medical University, Xi'an, Shaanxi Province, China
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Knight AR, Fry LE, Clancy RL, Pierce JD. Understanding the effects of oxygen administration in haemorrhagic shock. Nurs Crit Care 2011; 16:28-35. [PMID: 21199552 DOI: 10.1111/j.1478-5153.2010.00403.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
AIMS AND OBJECTIVES the aim of this article is to provide a review of the literature regarding oxygen administration and the use of oxygen in patients experiencing haemorrhagic shock (HS). RESULTS oxygen is administered to patients to assist them in maintaining oxygenation. The administration of oxygen is complex and varies significantly among patients. In order to optimize patient care, clinicians need to be aware of the potential effects, both beneficial and harmful, that oxygen can have on the body. INCLUSION AND EXCLUSION CRITERIA literature inclusion criteria for this article was any article (1995 to present) pertaining to oxygen administration and HS. Also included were articles related to tissue injury caused by an overabundance of free radicals with the administration of oxygen. Articles related to oxygen and wound healing, pollution, aerospace, food and industrial uses were excluded. CONCLUSIONS this review of the literature provides an overview of the use of oxygen in clinical practice and HS. The harmful effects of oxygen are highlighted to alert the clinician to this potential when there is an overabundance of oxygen. RELEVANCE TO CLINICAL PRACTICE oxygen is one of the most common drugs used in the medical community; however, the effects of oxygen on the body are not well understood. The use of oxygen if not prescribed correctly can cause cellular damage and death. Clinicians need to be more aware of the effects of oxygen and the damage it may cause if not administered properly.
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Affiliation(s)
- Amanda R Knight
- School of Nursing, University of Kansas Medical Center, Kansas City, KS 66160, USA.
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Small-volume d-β-hydroxybutyrate solution infusion increases survivability of lethal hemorrhagic shock in rats. Shock 2011; 34:565-72. [PMID: 20386494 DOI: 10.1097/shk.0b013e3181e15063] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
A small-volume therapeutic approach based on the biochemistry of hibernating mammals was evaluated to test the hypothesis that passive hypothermia and systemic administration of d-β-hydroxybutyrate (d-BHB) plus melatonin will increase survival of animals subjected to hemorrhagic shock ([HS] 60% blood loss). Anesthetized Sprague-Dawley male rats (320 ± 23 g) underwent controlled loss of 60% blood volume. Rats were instrumented to measure mean arterial pressure, body temperature (Tb), and heart rate. A passive decrease in rat Tb in response to HS significantly increased survival over animals maintained at 37°C (n = 5-6). Infusion of 4 M d-BHB, at a volume of only 5.5% of the total blood removed, significantly prolonged survival to a mean of 3 h compared with 90 min using equal osmolar 4 M NaCl (n = 6). In experiments where the shed blood was returned after 1 h of 60% blood loss, 4% fluid replacement with 4 M d-BHB plus 43 mM melatonin significantly prolonged survival up to 10 days after blood return compared with 4 M NaCl plus 43 mM melatonin and other control solutions (n = 10). We conclude that a slow decrease in animal Tb resulting from 60% blood loss, combined with infusion of 4 M d-BHB plus 43 mM melatonin, was beneficial for long-term survival after return of shed blood. This HS therapy is designed as a portable low-volume solution for further evaluation in a large-animal model and is ultimately intended for use in HS patients by first responders.
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Opreanu RC, Arrangoiz R, Stevens P, Morrison CA, Mosher BD, Kepros JP. Hematocrit, Systolic Blood Pressure and Heart Rate are not Accurate Predictors for Surgery to Control Hemorrhage in Injured Patients. Am Surg 2010. [DOI: 10.1177/000313481007600311] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Hematocrit (Hct), systolic blood pressure (SBP), and heart rate (HR) are considered to closely correlate with hypovolemia in injured patients. The clinical importance of these parameters in the early recognition of occult but clinically significant hemorrhage remains to be demonstrated. We undertook this study to assess the clinical importance of these parameters in the early recognition of occult hemorrhage in injured patients. A retrospective study of 7880 patients admitted to a Level I trauma center was carried out. Patients who underwent surgery were divided into the hemorrhage (n = 160) and no-hemorrhage group (n = 228). Hematocrit, SBP, and HR were correlated and receiver operating characteristic (ROC) curves were plotted. The ROC curves for Hct, SBP, and HR showed suboptimal areas under the graph. Even for different Hct thresholds and for hypotension and tachycardia, low predictive values were found. Although Hct, SBP, and HR levels were significantly altered among patients who require surgery for hemorrhage, the low predictive values of each parameter renders them as clinically unreliable individual tools for recognition of hemorrhagic patients who need surgery. Although useful in aggregate, as a pattern, or as indications for further diagnostic studies, these common parameters have limited usefulness individually
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Affiliation(s)
- Razvan C. Opreanu
- Department of Surgery, College of Human Medicine, Michigan State University, Lansing, Michigan
| | - Rodrigo Arrangoiz
- Department of Surgery, College of Human Medicine, Michigan State University, Lansing, Michigan
| | - Penny Stevens
- Division of Trauuma/Critical Care, Sparrow Health System, Lansing, Michigan
| | - Chet A. Morrison
- Department of Surgery, College of Human Medicine, Michigan State University, Lansing, Michigan
- Division of Trauuma/Critical Care, Sparrow Health System, Lansing, Michigan
| | - Benjamin D. Mosher
- Department of Surgery, College of Human Medicine, Michigan State University, Lansing, Michigan
- Division of Trauuma/Critical Care, Sparrow Health System, Lansing, Michigan
| | - John P. Kepros
- Department of Surgery, College of Human Medicine, Michigan State University, Lansing, Michigan
- Division of Trauuma/Critical Care, Sparrow Health System, Lansing, Michigan
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