Observations on Hemorrhagic Hypotension and Hemorrhagic Shock

Werle, J. M.; Cosby, Richard S.; Wiggers, Carl J.

doi:10.1152/ajplegacy.1942.136.3.401

Cited by 62 publications

(18 citation statements)

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“…The kinetics of cyt a,a3 reduction and Hb deoxygenation in response to tissue hypoxia in these experiments are entirely consistent with previously reported changes in brain tissue P02 in this laboratory (24), as well as observations by others (35). The decrease in relative cerebral blood volume after reinfusion may be due to the hemodilution commonly seen in shock (26). With the optical technique used here, we monitor the relative amount of Hb in the tissue and this value may not correlate directly with cerebral blood flow; during hemodilution cerebral blood flow may increase while the amount of Hb in the surveyed optical field decreases.…”

Section: Discussionsupporting

confidence: 92%

“…35 adult male Wistar rats (350-400 g) were anesthetized with intraperitoneal injection of sodium pentobarbital (30 The techniques for monitoring the redox state of cyt a,a3, using a differential spectrophotometer have been described previously (19,20,25 (26). The mean arterial pressure was regulated by intermittent minimal removal of blood over an interval of 40-50 min until the desired level of hypotension became stable with no further requirement for withdrawal of blood.…”

Section: In Vivo Experimentsmentioning

confidence: 99%

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Cytochrome a,a3 reoxidation. Early indicator of metabolic recovery from hemorrhagic shock in rats.

Kariman¹,

Jöbsis²,

Saltzman³

1983

J. Clin. Invest.

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A B S T R A C T To assess the metabolic recovery of mitochondria after injury, we have monitored, in vivo and noninvasively, changes in the redox state of cytochrome (cyt) a,a3 in 35 rats after tissue hypoxia induced by rapid exsanguination to a mean arterial pressure of 30-35 mmHg. This level of mean arterial pressure was maintained for a shorter period of time in group I (n = 17) and a longer period of time in group II (n = 18), then the shed blood was returned by infusion. The surviving animals were observed for 2 more h before terminating the experiments. During exsanguination, reinfusion and recovery intervals brain tissue parameters of blood oxygenation, relative blood volume, and cyt a,a3 redox state were monitored continuously by spectrophotometry through the closed skull and intact skin. Group I had a high survival rate while group II had a very low survival rate. In both groups, with the onset of hypotension, there was a prompt rapid shift, followed by a slow continued progressive shift, of cyt a,a3 toward a more reduced state. The extent of recovery of cyt a,a3 following reinfusion was different in each group. In group I there was a rapid reoxidation of cyt a,a3 to a level above the base line (16±12%, mean±SEM). In contrast, the extent of reoxidation of cyt a,a3 in group II was significantly lower and stayed 31±6% below the base-line level. To further evaluate the mechanisms responsible for these observations, another related experiment was performed. 12 rats were subjected to shock and resuscitation as outlined for groups I and II. After death or killing of the animal, we measured, in vitro, oxygen

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Section: Discussionsupporting

confidence: 92%

Section: In Vivo Experimentsmentioning

confidence: 99%

Cytochrome a,a3 reoxidation. Early indicator of metabolic recovery from hemorrhagic shock in rats.

Kariman¹,

Jöbsis²,

Saltzman³

1983

J. Clin. Invest.

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“…1. The dogs were bled to a mean arterial pressure of 45-50 mm Hg, according to a modification of the Wiggers technique (7). Bleeding was performed by opening a stopcock between the cannula and the bag which allowed the blood to flow into the bag.…”

Section: Methodsmentioning

confidence: 99%

Profile of Circulating Vasoactive Substances in Hemorrhagic Shock and Their Pharmacologic Manipulation

Jakschik¹,

Marshall²,

Kourik³

et al. 1974

J. Clin. Invest.

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A B S T R A C T (a)Hemorrhage(b) Plasma catecholamines (CA) steadily increased during hemorrhage and peaked during compensation (a 100-fold increase). The CA decreased progressively during decompensation.(c) Prostaglandin (PG) E-like material was observed in arterial blood for 15-60 min (after hemorrhage); the peak arterial concentration was 2.6 ng/ml blood. Indomethacin (i.v., before 80% of maximum bleedout): (i) confirmed the presence of PGE, (ii) increased blood pressure, and (iii) increased blood loss.(d) Thus: peripheral resistance during hemorrhagic shock seems temporally correlated with blood CA levels (and not PRA), and the renin-AII system contributes to the maintenance of vascular resistance and may markedly decrease perfusion of organs, such as kidney; the administration of the proper combination of specific antagonists of vasoconstrictor humoral substances may radically improve organ perfusion and could contribute to ultimate recovery from hemorrhagic shock.Preliminary results of this study were presented at the

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“…Briefly, 26 patients had no operation; 7 patients were not operated upon because their left atrial pressures were low, 2 because they were unfit as a result of other illness, 4 because of severe associated lesions of the heart, and 13 because of severe mitral incompetence. It is impossible to say how much the decision not to operate in this last group was influenced by the pressure record from the left atrium, but most certainly it was.…”

Section: Resultsmentioning

confidence: 99%

Bronchoscopic Method for Measuring Left Atrial Pressure

Gunning

1958

Circulation

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The possibility is examined that measurements from the records of left atrial pressure obtained by direct puncture of the left atrium through the bronchoscope might help in the diagnosis of mitral disease. The left atrial pressure records of 156 patients have been analyzed and the results are presented.IT WAS suggested that the record of left atrial pressure, obtained through the bronchoscope, might help to differentiate between mitral stenosis and mitral regurgitation and also to distinguish those patients in whom the mitral lesion is not the major cause of the symptoms.'The validity of these suggestions has been tested in a series of 156 patients. METHODThe apparatus used was the same as that prexviouslv described by Allison and Linden.`2 The manometer system was damped only by the puncturing needle and the degree of damping was 60 to 70 per cent of the critical value. It must be emphasized that in a system of this type no other damping is required. If, to eliminate artifacts, further damping is applied by electric or mechanical means, the amplitude of the recorded pressure pulse will be reduced, and inaccuracies of an unknown degree will occur.The Patient. At rapid heart rates the records of the left atrial pressure contours are less acemirate: (1) because the ratio of the frequency of the impressed force to the natural frequency of the manometer system is large and this causes distortion; and (2) [n all tracings an electrocardiogram and a phonocardiogram were recorded to facilitate the recognition of the individual waves of the pressure pulse contours. The method of measuring the records has been described previously,' but is briefly reviewed. The cardiac cycles to be examined were chosen from those that occurred during the expiratory phase. Pressures were then measured at 2 points in the atrial cycle: at the "Z" point,4 which is a point on the atrial pressure curve just before the beginning of the "c" wave, and at the top of the "v" wave. These 2 points of the atrial pressure curve correspond to the beginning and end of ventricular systole. A calculation was then made of the "miitral value" as described and discussed previously:' the difference between the pressures at the "V" and the "'' points (P,-Pz) is expressed as a percentage of the pressure at the top of the "v?' wave (P.). It is important to select the correct points on the curve at which to measure the pressures; these are illustrated in figure 1, which shows records froiii patients with sinus rhythm and with atrial fibrillation.Selection of Material. The records of patients accepted for this study were taken in order according to the numbers in the departmental files; but this is not truly an unselected series, as mere attendance at a thoracic surgical clinic infers some degree of selection.The cases were divided into groups, first according to the clinical diagnosis and, second, according to the findings at operation. The diagnoses of mitral stenosis, mitral regurgitation, and combined lesions were made from the now welldescribed symptomatology,...

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Observations on Hemorrhagic Hypotension and Hemorrhagic Shock

Cited by 62 publications

References 0 publications

Cytochrome a,a3 reoxidation. Early indicator of metabolic recovery from hemorrhagic shock in rats.

Cytochrome a,a3 reoxidation. Early indicator of metabolic recovery from hemorrhagic shock in rats.

Profile of Circulating Vasoactive Substances in Hemorrhagic Shock and Their Pharmacologic Manipulation

Bronchoscopic Method for Measuring Left Atrial Pressure

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