Intraoperative bleeding: a mathematical model for minimizing hemoglobin loss

Smetannikov, Y.; Hopkins, D. T.

doi:10.1046/j.1537-2995.1996.36996420764.x

Cited by 27 publications

(15 citation statements)

References 5 publications

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“…Various clinical situations similar to our experimental approach could initially or definitively benefit from this form of end-point directed fluid replacement: elective or emergency surgical procedures under general anesthesia, in which estimated blood loss has been shown to be both poorly reproducible and underestimated (21,22); sustained head injury, in which avoidance of hypotension is one of the most powerful predictors of outcome (23,24); subclinical gastrointestinal bleeding in sedated ICU patients who require tight continuous blood pressure control and resuscitation (25); conservatively treated blunt abdominal trauma (26), or the stationary phase following initial burn shock resuscitation (27). We assert that volume-intensive settings such as acute septic and burn shock resuscitation, penetrating trauma with substantial blood loss, uncontrolled hemorrhage of any kind or other similar events are explicitly not a target for the specific approach we used.…”

Section: Discussionmentioning

confidence: 99%

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Closed-Loop– and Decision-Assist–Guided Fluid Therapy of Human Hemorrhage*

Hundeshagen

Kramer

Marques

et al. 2017

Critical Care Medicine

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Objectives We sought to evaluate the efficacy, efficiency and physiological consequences of automated, end-point directed resuscitation systems and compare them to formula-based bolus resuscitation. Design Experimental human hemorrhage and resuscitation Setting Clinical Research Laboratory Subjects Healthy volunteers Interventions Subjects (n=7) were subjected to hemorrhage and underwent a randomized fluid resuscitation scheme on separate visits 1) formula-based bolus resuscitation (BR) 2) semi-autonomous (decision-assist, DA) fluid administration and 3) fully autonomous (closed-loop, CL) resuscitation. Hemodynamic parameters, volume shifts, fluid balance, and cardiac function were monitored during hemorrhage and resuscitation. Treatment modalities were compared based on resuscitation efficacy and efficiency. Measurements and Main Results All approaches achieved target BP by 60 min. Following hemorrhage, the total amount of infused fluid (BR: 30ml/kg, DA: 5.6±3 ml/kg, CL: 4.2±2ml/kg, p<0.001), plasma volume, extravascular volume (BR: 17±4ml/kg, DA: 3±1ml/kg, CL: -0.3±0.3ml/kg, p<0.001), body weight and urinary output remained stable under DA and CL and were significantly increased under bolus resuscitation. Mean arterial pressure initially decreased further under bolus resuscitation (-10mmHg, p<0.001) and was lower under BR than CL at 20min (BR: 57±2mmHg CL: 69±4mmHg, p=0.036). Colloid-osmotic pressure (BR: 19.3±2mmHg DA, CL: 24±0.4mmHg, p<0.05) and hemoglobin concentration were significantly decreased after bolus fluid administration. Conclusions We define efficacy of decision-assist and closed-loop resuscitation in human hemorrhage. In comparison to formula-based bolus resuscitation, both semiautonomous and autonomous approaches were more efficient in goal-directed resuscitation of hemorrhage. They provide favorable conditions for the avoidance of over-resuscitation and its adverse clinical sequelae. Decision-assist and closed-loop resuscitation algorithms are promising technological solutions for constrained environments and areas of limited resources.

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Section: Discussionmentioning

confidence: 99%

“…General anesthesia was maintained with a continuous infusion of propofol (75–150 μg/kg/min). A bispectral index (BIS) monitor (Covidien, Minneapolis MN) was used to titrate anesthesia depth to a BIS index of 50 throughout the study (21). BIS and propofol infusion rate were recorded every 15 minutes.…”

Section: Methodsmentioning

confidence: 99%

Closed-Loop– and Decision-Assist–Guided Fluid Therapy of Human Hemorrhage*

Hundeshagen

Kramer

Marques

et al. 2017

Critical Care Medicine

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“…The surgical time was an average of 45 min. The estimated range of blood loss was 110-280 ml, with an average 160 ml [6] . No patient was transfused either intraoperatively or postoperatively.…”

Section: Resultsmentioning

confidence: 99%

Prostate Fossa Packing: A Simple, Quick and Effective Method of Achieving Hemostasis in Suprapubic Prostatectomy

Mireku-Boateng

Jackson

2005

Urol Int

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Introduction: Suprapubic prostatectomy remains a very common surgical treatment for bladder outlet obstruction from an enlarged prostate in the developing world. It is a technically simple procedure which can be learned by nonurologists who perform the bulk of these procedures in the developing world. Intraoperative and postoperative bleeding, however, can be a problem. We describe our experience with prostatic fossa packing at the time of the procedure, as a very simple, quick and effective technique for maximal hemostasis. Material and Methods: We have used this technique for several years at our institution and the results have been excellent. However, the major advantages of this technique became highlighted when the primary author visited Eritrea on a medical mission trip and used it in 42 consecutive cases. We looked at the hemorrhagic complications, both intraoperatively and postoperatively, infections and other complications related to the technique. Results: The 42 patients were typical of the patients that are seen in the developing world for suprapubic prostatectomy. The age range was 49–102 years. 75% had indwelling urethral catheters secondary to urinary retention. The duration of the catheters was from 2 weeks to 10 months. All the patients who had the indwelling catheters had bacteriuria. 56% had associated bladder calculi and 25% had associated inguinal hernias. The average surgical time was 45 min. The average intraoperative blood loss was estimated at 160 ml. There were no blood transfusions. There were no infections and there were no complications related to the packing. Conclusion: Packing of the prostatic fossa at the time of enucleation of the adenoma is a very simple, quick and effective way to achieve hemostasis in suprapubic prostatectomy. It is also very easy to learn. With this technique we have achieved zero rate of transfusion and no infections. The surgical time is also reduced. We have had no morbidities associated with this technique and highly recommend it.

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“…Rapid intraoperative measurement of haemoglobin levels using near-patient testing may improve safety margins www.intechopen.com and avoid unnecessary transfusions (Loo 1997;Smetannikov 1996). However, intraoperative measurements must be interpreted in the context of a multifaceted clinical assessment of the patient in real time intraoperatively.…”

Section: Intraoperative Thresholdsmentioning

confidence: 99%