The Effects of Decreasing Low-Molecular Weight Hemoglobin Components of Hemoglobin-Based Oxygen Carriers in Swine With Hemorrhagic Shock
| Autor: | Daniel Freilich, Richard M. McCarron, Virginia T. Rentko, Sarah Collier, Paula Moon-Massatt, Thomas Steinbach, Rick Light, Michael Handrigan, L. Bruce Pearce, Nora Philbin, Jennifer Rice, Nina Malkevich, Francoise Arnaud, Gerry McGwin, Stephen T. Ahlers |
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| Rok vydání: | 2008 |
| Předmět: |
medicine.medical_specialty
Swine Resuscitation Blood Pressure Blood volume Shock Hemorrhagic Critical Care and Intensive Care Medicine Methemoglobin Blood Substitutes Internal medicine medicine Animals Pulmonary wedge pressure Diminution business.industry Molecular Weight Disease Models Animal medicine.anatomical_structure Blood pressure Endocrinology Regional Blood Flow Anesthesia Vascular resistance Female Surgery Base excess Hemoglobin business |
| Zdroj: | Journal of Trauma: Injury, Infection & Critical Care. 64:1240-1257 |
| ISSN: | 0022-5282 |
| Popis: | Background: Some hemoglobin-based oxygen carriers (HBOCs) improve outcome in animal models of hemorrhagic shock (HS) in comparison with standard asanguinous resuscitation fluids. Nevertheless, concern about intrinsic vasoactivity, linked in part to low-molecular weight (MW) hemoglobin (Hb), has slowed HBOC development. We assessed the impact of decreasing the low-MW Hb component of bovine HBOC on vasoactivity in severe HS. Methods: Anesthetized invasively monitored swine were hemorrhaged 55% blood volume and resuscitated with bovine HBOC containing 31% (31 TD [HBOC-301]), 2% (2 TD [HBOC-201]), or 0.4% (0.4 TD) low-MW Hb. Pigs received four 10 mL/kg infusions over 60 minutes, hospital arrival was simulated at 75 minutes, organ blood flow (BF) was evaluated by microsphere injection, and monitoring was continued for 4 hours followed by complete necrotic evaluation. Results: There were few differences between 2 TD and 0.4 TD. Thirty-one TD pigs had higher systemic and pulmonary blood pressure (BP), systemic vascular resistance index, and pulmonary artery wedge pressure, compared with 2 TD or 0.4 TD (p < 0.01); however, pigs in all groups had at least mildly elevated BP. Transcutaneous tissue oxygenation, base excess, and mixed venous oxygen saturation were similar across groups; lactate and methemoglobin were highest with 0.4 TD (p < 0.03). There were no group differences in BF. Over time, myocardial BF increased and hepatic BF decreased in all groups (for 31 TD, p < 0.05); renal BF was unchanged in all groups. There were no group differences in heart, lung, or liver histopathology, and survival. Conclusions: Although purification from 31% to 2% low-MW Hb content significantly decreased vasoactive responses, further purification to 0.4% had no additional clinically measurable effects in severe HS. If further diminution in HBOC vasoactivity is desired for use in HS, additional technical approaches may be required. |
| Databáze: | OpenAIRE |
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