Physiologic responses to severe hemorrhagic shock and the?genesis of cardiovascular collapse: Can irreversibility be?anticipated?

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• 作者：Hernando Gó ; mez ; MD^a ; ^{gomezh@upmc.edu} ; Jaume Mesquida ; MD ; PhD^b ; Linda Hermus ; MD^c ; Patricio Polanco ; MD^c ; Hyung Kook Kim ; MD^a ; Sven Zenker ; MD^d ; André ; s Torres ; MD^c ; Rajaie Namas ; MD^e ; Yoram Vodovotz ; PhD^c ; Gilles Clermont ; MD^a ; Juan Carlos Puyana ; MD^c ; Michael R. Pinsky ; MD^a
• 关键词：Animal model ; Autonomic control ; Lactate ; Vasomotor tone
• 刊名：Journal of Surgical Research
• 出版年：2012
• 出版时间：November, 2012
• 年：2012
• 卷：178
• 期：1
• 页码：358-369
• 全文大小：985 K

文摘

Background

The causes of cardiovascular collapse (CC) during hemorrhagic shock (HS) are unknown. We hypothesized that vascular tone loss characterizes CC, and that arterial pulse pressure/stroke volume index ratio or vascular tone index (VTI) would identify CC.

Methods

Fourteen Yorkshire-Durock pigs were bled to 30 mmHg mean arterial pressure and held there by repetitive bleeding until rendered unable to compensate (CC) or for 90 min (NoCC). They were then resuscitated in equal parts to shed volume and observed for 2 h. CC was defined as a MAP < 30 mmHg for 10 min or <20 mmHg for 10 s. Study variables were recorded at baseline (B0), 30, 60, 90 min after bleeding and at resuscitation (R0), 30, and 60 min afterward.

Results

Swine were bled to 32 % ¡À 9 % of total blood volume. Epinephrine (Epi) and VTI were low and did not change in NoCC after bleeding compared with CC swine, in which both increased (0.97 ¡À 0.22 to 2.57 ¡À 1.42 mcg/dL, and 173 ¡À 181 to 939 ¡À 474 mmHg/mL, respectively), despite no differences in bled volume. Lactate increase rate (LIR) increased with hemorrhage and was higher at R0 for CC, but did not vary in NoCC. VTI identified CC from NoCC and survivors from non-survivors before CC. A large increase in LIR was coincident with VTI decrement before CC occurred.

Conclusions

Vasodilatation immediately prior to CC in severe HS occurs at the same time as an increase in LIR, suggesting loss of tone as the mechanism causing CC, and energy failure as its probable cause.