Hemorheological changes in ischemia-reperfusion: An overview on our experimental surgical data

Németh, Norbert; Furka, I.; Miko, Iren

doi:10.3233/ch-131648

Cited by 26 publications

(20 citation statements)

References 70 publications

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“…Our results suggest that those animals which show very significant falls in microcirculatory impairment during the shock period never return to baseline values of perfusion, in contrast to those with more modest initial falls in perfused vessel density. Possible explanations for persisting microcirculatory failure after restoration of systemic blood flow include dysfunction of any or all of the individual elements that make up the microcirculation, for example, endothelial cell swelling caused by ischaemia and re-perfusion injury [ 22 ], clogging of small vessels with activated leucocytes [ 23 ] and dysfunction of transfused stored erythrocytes leading to vessel occlusion [ 24 ]. Our study was only designed to assess the initial response of the microcirculation to shock and resuscitation, and further studies are required to answer these interesting questions relating to the precise mechanisms behind persistent microcirculatory dysfunction.…”

Section: Discussionmentioning

confidence: 99%

Microcirculatory perfusion shows wide inter-individual variation and is important in determining shock reversal during resuscitation in a porcine experimental model of complex traumatic hemorrhagic shock

Hutchings

Naumann

Watts

et al. 2016

ICMx

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BackgroundTraumatic hemorrhagic shock (THS) is a leading cause of preventable death following severe traumatic injury. Resuscitation of THS is typically targeted at blood pressure, but the effects of such a strategy on systemic and microcirculatory flow remains unclear. Failure to restore microcirculatory perfusion has been shown to lead to poor outcomes in experimental and clinical studies. Systemic and microcirculatory variables were examined in a porcine model of complex THS, in order to investigate inter-individual variations in flow and the effect of microcirculatory perfusion on reversal of the shock state.MethodsBaseline standard microcirculatory variables were obtained for 22 large white pigs using sublingual incident dark field (IDF) video-microscopy. All animals were subjected to a standardised hind-limb injury followed by a controlled haemorrhage of approximately 35 % of blood volume (shock phase). This was followed by 60 min of fluid resuscitation with either 0.9 % saline or component blood products and a target SBP of 80 mmHg (early resuscitation phase). All animals were then given blood products to a target SBP of 110 mmHg for 120 min (mid-resuscitation phase), and a further 100 min (late resuscitation phase). IDF readings were obtained at the midpoint of each of these phases. Cardiac output was measured using a pulmonary artery catheter. Animals were divided into above average (A) and below average (B) perfused vessel density (PVD) groups based on the lowest recorded PVD measurement taken during the shock and early resuscitation phases.ResultsThere was minimal inter-individual variation in blood pressure but wide variation of both systemic and microcirculatory flow variables during resuscitation. During shock and early resuscitation, group A (n = 10) had a mean PVD of 10.5 (SD ± 2.5) mm/mm2 and group B (n = 12) 5.5 (SD ± 4.1) mm/mm2. During the later resuscitation phases, group A maintained a significantly higher PVD than group B. Group A initially had a higher cardiac output, but the difference between the groups narrowed as resuscitation progressed. At the end of resuscitation, group A had significantly lower plasma lactate, higher lactate clearance, lower standard base deficit and smaller mixed venous-arterial CO2 gradient. There was no significant difference in blood pressure between the two groups at any stage.ConclusionThere was a wide variation in both macro- and microcirculatory flow variables in this pressure-targeted experimental model of THS resuscitation. Early changes in microvascular perfusion appear to be key determinants in the reversal of the shock state during resuscitation. Microcirculatory flow parameters may be more reliable markers of physiological insult than pressure-based parameters and are potential targets for goal-directed resuscitation.Electronic supplementary materialThe online version of this article (doi:10.1186/s40635-016-0088-z) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Microcirculatory perfusion shows wide inter-individual variation and is important in determining shock reversal during resuscitation in a porcine experimental model of complex traumatic hemorrhagic shock

Hutchings

Naumann

Watts

et al. 2016

ICMx

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“…Because hemorheological parameters have been found to be associated with I/R [ 18 – 20 ], we also measured whole blood viscosity (WBV), erythrocyte sedimentation rate (ESR), and hematocrit (Htc). WBV at shear rates of 200 s −1 , 50 s −1 , and 10 s −1 was discovered to increase significantly from 3.52 ± 0.29 mPa·s/200 s −1 , 3.88 ± 0.35 mPa·s/50 s −1 , and 4.71 ± 0.48 mPa·s/10 s −1 in the sham operation group to 4.23 ± 0.42 mPa·s/200 s −1 , 4.75 ± 0.44 mPa·s/50 s −1 , and 5.68 ± 2.56 mPa·s/10 s −1 in the I/R group, respectively (each n = 6, P < 0.01; Table 3 ).…”

Section: Resultsmentioning

confidence: 99%

Dunye Guanxinning Improves Acute Myocardial Ischemia-Reperfusion Injury by Inhibiting Neutrophil Infiltration and Caspase-1 Activity

Zhang

Wang

Chen

et al. 2018

Mediators of Inflammation

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Acute myocardial infarction is the most serious manifestation of cardiovascular disease, and it is a life-threatening condition. Dunye Guanxinning (DG) is a protective traditional Chinese patent herbal medicine with high clinical efficacy and suitable for the treatment of myocardial infarction. However, the mechanism through which it is beneficial is unclear. In this study, we hypothesized that DG improves acute myocardial ischemia-reperfusion injury by inhibiting neutrophil infiltration and caspase-1 activity. We found that DG administration decreased infarct size and cardiomyocyte apoptosis and improved left ventricular ejection fraction, fractional shortening, end-systolic volume index, end-systolic diameter, and carotid arterial blood flow output in rats. DG administration also improved hemorheological parameters, myocardial damage biomarkers, and oxidative stress indexes. The findings showed that DG administration inhibited neutrophil infiltration and reduced the serum interleukin-1 beta (IL-1β) level and myocardial IL-1β maturation. Moreover, DG administration inhibited caspase-1 activity and activated adenosine monophosphate-activated protein kinase (AMPK) phosphorylation in rat hearts. These results suggested that DG administration inhibits inflammasome activity and IL-1β release through the AMPK pathway. Our findings support the clinical efficacy of DG and partially reveal its mechanism, which is beneficial for understanding the therapeutic effects of this protective traditional Chinese patent drug.

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“…Given the development and changes in the morphological characteristics of schistocytes, the TMA score was developed to screen for TAMOF in critically ill patients as a rapid, simple marker [15]. With respect to erythrocytes, the hemorheological state after ischemia and reperfusion may negatively impact the deformability and aggregation behavior of RBCs through several complex process including acute phase reactions, free radical and in ammatory response, hemodynamic deteriorations, and coagulopathy [29]. Yu et al assessed the rheological properties of RBC after ischemic/reperfusion and reported that stiffer erythrocytes resulting from reduced deformability help increase vascular resistance by limiting movement to small tissue capillaries.…”

Section: Discussionmentioning

confidence: 99%

“…Although changes in the microcirculation are known to play an important role in the severity of organ damage after CA, only few studies have investigated the characteristic changes for RBC deformability after CA and ischemic/reperfusion injury [36]. [29]. The limited number of studies prompts us to refer to the signi cant association between sepsis and DIC.…”

Section: Discussionmentioning

confidence: 99%

Thrombotic Microangiopathy Score as a New Predictor for Neurologic Outcome in Patients Undergoing Targeted Temperature Management After Out-of-hospital Cardiac Arrest

Kong

Lee

Jeon

et al. 2020

Preprint

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Abstract Background: Given the morphological characteristics of schistocytes, thrombotic microangiopathy (TMA) score can be beneficial as it can be quickly and serially measured without additional effort or costs. This study aimed to investigate whether the serial TMA scores until 48 h post admission are associated with clinical outcomes in patients undergoing targeted temperature management (TTM) after out-of-hospital cardiac arrest (OHCA). Methods:We retrospectively evaluated a cohort of 185 patients using a prospective registry. We analyzed the TMA score at admission and after 12, 24, and 48 hours. The primary outcome measures were poor neurologic outcome at discharge and 30-day mortality. Results:Increased TMA scores at all measured time points were independent predictors of poor neurologic outcomes and 30-day mortality, with the TMA score at time-12 showing the strongest correlation (OR, 3.008; 95% CI, 1.707–5.3; p=0.001 and HR, 1.517; 95% CI, 1.196–1.925; p=0.001.Specifically, TMA score ≥2 at time-12 was closely associated with increased predictability of poor neurologic outcome (OR, 6.302; 95% CI: 2.841–13.976; p<0.001) and 30-day mortality (HR, 2.656; 95% CI: 1.675–4.211; p<0.001).Conclusions: Increased TMA scores predicted the neurologic outcome and 30-day mortalityin patients undergoing TTM after OHCA. In addition to the benefit of being quickly and serially measured by using an automated hematology analyzer without additional effort or costs, this finding indicates that the TMA score may be a helpful tool for rapid risk stratification and identification of the need for intensive care in patients with ROSC after OHCA.

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Hemorheological changes in ischemia-reperfusion: An overview on our experimental surgical data

Cited by 26 publications

References 70 publications

Microcirculatory perfusion shows wide inter-individual variation and is important in determining shock reversal during resuscitation in a porcine experimental model of complex traumatic hemorrhagic shock

Microcirculatory perfusion shows wide inter-individual variation and is important in determining shock reversal during resuscitation in a porcine experimental model of complex traumatic hemorrhagic shock

Dunye Guanxinning Improves Acute Myocardial Ischemia-Reperfusion Injury by Inhibiting Neutrophil Infiltration and Caspase-1 Activity

Thrombotic Microangiopathy Score as a New Predictor for Neurologic Outcome in Patients Undergoing Targeted Temperature Management After Out-of-hospital Cardiac Arrest

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