CRITICAL POINT IN PROGRESSIVE HEMODILUTION WITH HYDROXYETHYL STARCH

• Published in: KAWASAKI MEDICAL JOURNAL Vol. 2; no. 4; pp. 211 - 222
• Main Authors: Masuhiko TAKAORI, Peter SAFAR
• Format: Journal Article
• Language: Japanese
• Published: Kawasaki Medical Society 1976
• ISSN: 0385-0234

Abstract Anesthetized dogs were hemodiluted by serial blood withdrawals （10 ml/kg）and immediate infusion of equal volumes of hydroxyethyl starch solution every ten minutes until death. Serial determinations of circulatory and metabolic parameters were performed at approximately 20, 12, 8 and 5％ hematocrit values. “Complete compensation ” was observed until Hb value reached approximately 5.5 g/100 ml.“Partial compensation”was observed at 5.5-4.0 g/100 ml Hb, where oxygen consumption started to decline. “Reversible decompensation” occurred at hemoglobin values of 4.0-3.0 g/100 ml for the following reasons：cardiac output declined from its maximal compensatory increase ；heart rate and arterial pressure decreased ；right ventricular end-diastolic pressure increased ； venous hemogloblin oxygen saturation decreased sharply ； pH declined and arterial lactate values rose ；and reversibility of hemodilution proven by survival of 80％ of 43 animals in the previous studies. “Irreversible decompensation” occurred below 3.0 g/100 ml Hb. This is characterized by a dramatic decrease in cardiac output and venous hemoglobin oxygen saturation ； and an increase in arteriovenous oxygen content difrerence. The lowest hemoglobin values measured（1.5-2.0 g/100 ml）were followed by another 3-7 blood exchanges before cardiac arrest occurred suddenly.