Blood Substitute Resuscitation as a Treatment Modality for Moderate Hypovolemia
Blood substitute resuscitation as a treatment modality for moderate hypovolemia (˜40% blood loss) in a canine model has been evaluated using Oxyglobin® (Biopure Hemoglobin Glutamer-200 Bovine; a hemoglobin-based oxygen-carrier) and Hespan® (6% hetastarch; a nonoxygen-carrier) as resuscitants. Autolo...
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Published in | Artificial cells, blood substitutes, and immobilization biotechnology Vol. 32; no. 2; pp. 189 - 207 |
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Main Authors | , , , , , , |
Format | Journal Article |
Language | English |
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England
Informa UK Ltd
01.01.2004
Taylor & Francis |
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Abstract | Blood substitute resuscitation as a treatment modality for moderate hypovolemia (˜40% blood loss) in a canine model has been evaluated using Oxyglobin® (Biopure Hemoglobin Glutamer-200 Bovine; a hemoglobin-based oxygen-carrier) and Hespan® (6% hetastarch; a nonoxygen-carrier) as resuscitants. Autologous (shed) blood served as control. Nine dogs were studied-after splenectomy, each dog was hemorrhaged (32-36 mL kg; MAP = ˜50 mmHg) and randomly assigned to the three resuscitation groups. Microvascular, systemic function and oxygenation characteristics were monitored and or measured simultaneously in prehemorrhagic (baseline), posthemorrhagic and postresuscitation phases for correlation-real-time microvascular changes in the bulbar conjunctiva were noninvasively measured via computer-assisted intravital microscopy and systemic function and oxygenation changes were monitored and or measured via instrumentation and devices incorporated into our bioengineering station in an operating room setting. Blood chemistry was also studied for relevant measurements. Prehemorrhagic microvascular characteristics were similar in all animals (venular diameter = 41 ± 12 µm, A:V ratio = ˜1:2, red-cell velocity = 0.5 ± 0.3 mm s). All animals also showed similar prehemorrhagic systemic function and oxygenation measurements comparable to a previous study and were consistent with normal measurements in dogs. At the completion of hemorrhaging to achieve moderate hypovolemia (˜40% blood loss with MAP at ˜50 mmHg), all nine animals showed similar significant (P < 0.01) posthemorrhagic microvascular changes, including ˜17% decrease in diameter (34 ± 7 µm), A:V ratio = variable, and ˜80% increase in velocity (0.9 ± 0.5 mm s). All animals also showed similar significant (P < 0.01) posthemorrhagic systemic function and oxygenation changes, with decreases in Hct, aHbtotal, MPAP, MAP, SAP, DAP, CO, SVI, CaO2, and CvO2 and increases in HR and lactic acidosis. Shed blood (control) resuscitation restored posthemorrhagic microvascular changes close to prehemorrhagic values (diameter = 39 ± 6 µm, A:V ratio = ˜1:2, velocity = 0.6 ± 0.4 mm s). Oxyglobin® and Hespan® restored microvascular changes in similar manner close to prehemorrhagic values (Oxyglobin®: diameter = 38 ± 3 µm, A:V ratio = ˜1:2, velocity = 0.6 ± 0.4 mm s; Hespan®: diameter = 38 ± 7 µm, A:V ratio = ˜1:2, velocity = 0.5 ± 0.4 mm s). After resuscitation, shed blood (control) restored all systemic function and oxygenation changes close to prehemorrhagic values. However, both Oxyglobin® and Hespan® resuscitation restored systemic function changes, but not oxygenation changes, to prehemorrhagic values. This was an interesting finding because of the different oxygen-carrying capability of Oxyglobin® (oxygen-carrying) and Hespan® (nonoxygen-carrying). The result suggests that either volume replenishment alone (and not oxygen-carrying capability) is needed to treat moderate hypovolemia or oxygenation measurements obtained by standard methods (oximetry, blood chemistry) may not reflect tissue oxygenation levels. |
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AbstractList | Blood substitute resuscitation as a treatment modality for moderate hypovolemia (˜40% blood loss) in a canine model has been evaluated using Oxyglobin® (Biopure Hemoglobin Glutamer-200/Bovine; a hemoglobin-based oxygen-carrier) and Hespan® (6% hetastarch; a nonoxygen-carrier) as resuscitants. Autologous (shed) blood served as control. Nine dogs were studied-after splenectomy, each dog was hemorrhaged (32-36 mL/kg; MAP = ˜50 mmHg) and randomly assigned to the three resuscitation groups. Microvascular, systemic function and oxygenation characteristics were monitored and/or measured simultaneously in prehemorrhagic (baseline), posthemorrhagic and postresuscitation phases for correlation-real-time microvascular changes in the bulbar conjunctiva were noninvasively measured via computer-assisted intravital microscopy and systemic function and oxygenation changes were monitored and/or measured via instrumentation and devices incorporated into our bioengineering station in an operating room setting. Blood chemistry was also studied for relevant measurements. Prehemorrhagic microvascular characteristics were similar in all animals (venular diameter = 41 ± 12 µm, A:V ratio = ˜1:2, red-cell velocity = 0.5 ± 0.3 mm/s). All animals also showed similar prehemorrhagic systemic function and oxygenation measurements comparable to a previous study and were consistent with normal measurements in dogs. At the completion of hemorrhaging to achieve moderate hypovolemia (˜40% blood loss with MAP at ˜50 mmHg), all nine animals showed similar significant (P < 0.01) posthemorrhagic microvascular changes, including ˜17% decrease in diameter (34 ± 7 µm), A:V ratio = variable, and ˜80% increase in velocity (0.9 ± 0.5 mm/s). All animals also showed similar significant (P < 0.01) posthemorrhagic systemic function and oxygenation changes, with decreases in Hct, aHb
total
, MPAP, MAP, SAP, DAP, CO, SVI, CaO
2
, and CvO
2
and increases in HR and lactic acidosis. Shed blood (control) resuscitation restored posthemorrhagic microvascular changes close to prehemorrhagic values (diameter = 39 ± 6 µm, A:V ratio = ˜1:2, velocity = 0.6 ± 0.4 mm/s). Oxyglobin® and Hespan® restored microvascular changes in similar manner close to prehemorrhagic values (Oxyglobin®: diameter = 38 ± 3 µm, A:V ratio = ˜1:2, velocity = 0.6 ± 0.4 mm/s; Hespan®: diameter = 38 ± 7 µm, A:V ratio = ˜1:2, velocity = 0.5 ± 0.4 mm/s). After resuscitation, shed blood (control) restored all systemic function and oxygenation changes close to prehemorrhagic values. However, both Oxyglobin® and Hespan® resuscitation restored systemic function changes, but not oxygenation changes, to prehemorrhagic values. This was an interesting finding because of the different oxygen-carrying capability of Oxyglobin® (oxygen-carrying) and Hespan® (nonoxygen-carrying). The result suggests that either volume replenishment alone (and not oxygen-carrying capability) is needed to treat moderate hypovolemia or oxygenation measurements obtained by standard methods (oximetry, blood chemistry) may not reflect tissue oxygenation levels. Blood substitute resuscitation as a treatment modality for moderate hypovolemia (approximately 40% blood loss) in a canine model has been evaluated using Oxyglobin (Biopure Hemoglobin Glutamer-200/ Bovine; a hemoglobin-based oxygen-carrier) and Hespan (6% hetastarch; a nonoxygen-carrier) as resuscitants. Autologous (shed) blood served as control. Nine dogs were studied--after splenectomy, each dog was hemorrhaged (32-36 mL/kg; MAP = approximately 50 mmHg) and randomly assigned to the three resuscitation groups. Microvascular, systemic function and oxygenation characteristics were monitored and/or measured simultaneously in prehemorrhagic (baseline), posthemorrhagic and postresuscitation phases for correlation-real-time microvascular changes in the bulbar conjunctiva were noninvasively measured via computer-assisted intravital microscopy and systemic function and oxygenation changes were monitored and/or measured via instrumentation and devices incorporated into our bioengineering station in an operating room setting. Blood chemistry was also studied for relevant measurements. Prehemorrhagic microvascular characteristics were similar in all animals (venular diameter = 41 +/- 12 microm, A:V ratio = approximately 1:2, red-cell velocity = 0.5 +/- 0.3 mm/s). All animals also showed similar prehemorrhagic systemic function and oxygenation measurements comparable to a previous study and were consistent with normal measurements in dogs. At the completion of hemorrhaging to achieve moderate hypovolemia (approximately 40% blood loss with MAP at approximately 50 mmHg), all nine animals showed similar significant (P < 0.01) posthemorrhagic microvascular changes, including approximately 17% decrease in diameter (34 +/- 7 microm), A:V ratio = variable, and approximately 80% increase in velocity (0.9 +/- 0.5 mm/s). All animals also showed similar significant (P < 0.01) posthemorrhagic systemic function and oxygenation changes, with decreases in Hct, aHb(total), MPAP, MAP, SAP, DAP, CO, SVI, CaO2, and CvO2 and increases in HR and lactic acidosis. Shed blood (control) resuscitation restored posthemorrhagic microvascular changes close to prehemorrhagic values (diameter = 39 +/- 6 microm, A:V ratio = approximately 1:2, velocity = 0.6 +/- 0.4 mm/s). Oxyglobin and Hespan restored microvascular changes in similar manner close to prehemorrhagic values (Oxyglobin: diameter = 38 +/- 3 microm, A:V ratio = approximately 1:2, velocity = 0.6 +/- 0.4 mm/s; Hespan: diameter = 38 +/- 7 microm, A:V ratio = 1:2, velocity = 0.5 +/- 0.4 mm/s). After resuscitation, shed blood (control) restored all systemic function and oxygenation changes close to prehemorrhagic values. However, both Oxyglobin and Hespan resuscitation restored systemic function changes, but not oxygenation changes, to prehemorrhagic values. This was an interesting finding because of the different oxygen-carrying capability of Oxyglobin (oxygen-carrying) and Hespan (nonoxygen-carrying). The result suggests that either volume replenishment alone (and not oxygen-carrying capability) is needed to treat moderate hypovolemia or oxygenation measurements obtained by standard methods (oximetry, blood chemistry) may not reflect tissue oxygenation levels. Blood substitute resuscitation as a treatment modality for moderate hypovolemia (˜40% blood loss) in a canine model has been evaluated using Oxyglobin® (Biopure Hemoglobin Glutamer-200 Bovine; a hemoglobin-based oxygen-carrier) and Hespan® (6% hetastarch; a nonoxygen-carrier) as resuscitants. Autologous (shed) blood served as control. Nine dogs were studied-after splenectomy, each dog was hemorrhaged (32-36 mL kg; MAP = ˜50 mmHg) and randomly assigned to the three resuscitation groups. Microvascular, systemic function and oxygenation characteristics were monitored and or measured simultaneously in prehemorrhagic (baseline), posthemorrhagic and postresuscitation phases for correlation-real-time microvascular changes in the bulbar conjunctiva were noninvasively measured via computer-assisted intravital microscopy and systemic function and oxygenation changes were monitored and or measured via instrumentation and devices incorporated into our bioengineering station in an operating room setting. Blood chemistry was also studied for relevant measurements. Prehemorrhagic microvascular characteristics were similar in all animals (venular diameter = 41 ± 12 µm, A:V ratio = ˜1:2, red-cell velocity = 0.5 ± 0.3 mm s). All animals also showed similar prehemorrhagic systemic function and oxygenation measurements comparable to a previous study and were consistent with normal measurements in dogs. At the completion of hemorrhaging to achieve moderate hypovolemia (˜40% blood loss with MAP at ˜50 mmHg), all nine animals showed similar significant (P < 0.01) posthemorrhagic microvascular changes, including ˜17% decrease in diameter (34 ± 7 µm), A:V ratio = variable, and ˜80% increase in velocity (0.9 ± 0.5 mm s). All animals also showed similar significant (P < 0.01) posthemorrhagic systemic function and oxygenation changes, with decreases in Hct, aHbtotal, MPAP, MAP, SAP, DAP, CO, SVI, CaO2, and CvO2 and increases in HR and lactic acidosis. Shed blood (control) resuscitation restored posthemorrhagic microvascular changes close to prehemorrhagic values (diameter = 39 ± 6 µm, A:V ratio = ˜1:2, velocity = 0.6 ± 0.4 mm s). Oxyglobin® and Hespan® restored microvascular changes in similar manner close to prehemorrhagic values (Oxyglobin®: diameter = 38 ± 3 µm, A:V ratio = ˜1:2, velocity = 0.6 ± 0.4 mm s; Hespan®: diameter = 38 ± 7 µm, A:V ratio = ˜1:2, velocity = 0.5 ± 0.4 mm s). After resuscitation, shed blood (control) restored all systemic function and oxygenation changes close to prehemorrhagic values. However, both Oxyglobin® and Hespan® resuscitation restored systemic function changes, but not oxygenation changes, to prehemorrhagic values. This was an interesting finding because of the different oxygen-carrying capability of Oxyglobin® (oxygen-carrying) and Hespan® (nonoxygen-carrying). The result suggests that either volume replenishment alone (and not oxygen-carrying capability) is needed to treat moderate hypovolemia or oxygenation measurements obtained by standard methods (oximetry, blood chemistry) may not reflect tissue oxygenation levels. |
Author | Duong, Patricia L. Driessen, Bernd Chen, Peter C. Y. Ramanujam, Sahana Jahr, Jonathan S. Cheung, Anthony T. W. Gunther, Robert A. |
Author_xml | – sequence: 1 givenname: Anthony T. W. surname: Cheung fullname: Cheung, Anthony T. W. email: atcheung@ucdavis.edu organization: 1Department of Medical Pathology, University of California, Davis School of Medicine, Sacramento, California, USA – sequence: 2 givenname: Bernd surname: Driessen fullname: Driessen, Bernd email: atcheung@ucdavis.edu organization: 1Department of Medical Pathology, University of California, Davis School of Medicine, Sacramento, California, USA – sequence: 3 givenname: Jonathan S. surname: Jahr fullname: Jahr, Jonathan S. email: atcheung@ucdavis.edu organization: 1Department of Medical Pathology, University of California, Davis School of Medicine, Sacramento, California, USA – sequence: 4 givenname: Patricia L. surname: Duong fullname: Duong, Patricia L. email: atcheung@ucdavis.edu organization: 1Department of Medical Pathology, University of California, Davis School of Medicine, Sacramento, California, USA – sequence: 5 givenname: Sahana surname: Ramanujam fullname: Ramanujam, Sahana email: atcheung@ucdavis.edu organization: 1Department of Medical Pathology, University of California, Davis School of Medicine, Sacramento, California, USA – sequence: 6 givenname: Peter C. Y. surname: Chen fullname: Chen, Peter C. Y. email: atcheung@ucdavis.edu organization: 1Department of Medical Pathology, University of California, Davis School of Medicine, Sacramento, California, USA – sequence: 7 givenname: Robert A. surname: Gunther fullname: Gunther, Robert A. email: atcheung@ucdavis.edu organization: 1Department of Medical Pathology, University of California, Davis School of Medicine, Sacramento, California, USA |
BackLink | https://www.ncbi.nlm.nih.gov/pubmed/15274428$$D View this record in MEDLINE/PubMed |
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Cites_doi | 10.1182/blood.V99.11.3999 10.1006/mvre.2001.2386 10.1097/00003246-199605000-00006 10.1146/annurev.med.50.1.337 10.1046/j.1365-2885.2001.00307.x 10.1097/00007890-199910150-00005 10.1097/00003246-199403000-00019 10.1046/j.1537-2995.1998.38798346630.x 10.4158/EP.7.5.358 10.1182/blood.V97.11.3401 10.3109/10731199409117408 10.1016/S1096-2867(99)80024-3 10.1097/00000539-200110000-00007 10.1093/bja/86.5.683 10.2165/00003088-199529040-00003 10.1097/01.CCM.0000063476.79749.C1 10.1080/713773960 10.1056/NEJM200006013422211 |
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Snippet | Blood substitute resuscitation as a treatment modality for moderate hypovolemia (˜40% blood loss) in a canine model has been evaluated using Oxyglobin®... Blood substitute resuscitation as a treatment modality for moderate hypovolemia (approximately 40% blood loss) in a canine model has been evaluated using... |
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SubjectTerms | Animals Blood Substitutes - pharmacology Blood Substitutes - therapeutic use Conjunctiva - cytology Conjunctiva - drug effects Dogs Female Hemodynamics - drug effects Hemoglobins Hemorrhage - etiology Hemorrhage - metabolism Hydroxyethyl Starch Derivatives - pharmacology Hydroxyethyl Starch Derivatives - therapeutic use Hypovolemia - drug therapy Hypovolemia - metabolism Male Microcirculation - cytology Microcirculation - drug effects Models, Animal Oxygen Consumption - drug effects |
Title | Blood Substitute Resuscitation as a Treatment Modality for Moderate Hypovolemia |
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