Oxygen debt and metabolic acidemia as quantitative predictors of mortality and the severity of the ischemic insult in hemorrhagic shock

Dunham, C. Michael; Siegel, John H.; Weireter, Leonard J.; Fabian, M.; Goodarzi, Shirin; Guadalupi, Pietro; Gettings, Lisa; Linberg, Steven E.; Vary, Thomas C.

doi:10.1097/00003246-199102000-00020

Cited by 278 publications

(141 citation statements)

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“…This metabolic acidosis is the most likely result of tissue hypoperfusion and anaerobic metabolism, leading to a significant increase in circulating lactate levels. Blood lactate levels in hemorrhagic shock are used increasingly as reliable indicators of the severity of injury and the adequacy of fluid resuscitation [21,22]. In our model, cumulative hemorrhage resulted in a twofold plasma lactic acid increase at 9 h and threefold at 18 h in group 1, which was higher and increased earlier than those in group 2.…”

Section: Discussionmentioning

confidence: 89%

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The physiological changes of cumulative hemorrhagic shock in conscious rats

et al. 2006

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SummaryHemorrhagic shock is a common cause of death in emergency rooms. Current animal models of hemorrhage encounter a major problem that the volume and the rate of blood loss cannot be controlled. In addition, the use of anesthesia obscures physiological responses. Our experiments were designed to establish an animal model based on the clinical situation for studying hemorrhagic shock. Hemorrhagic shock was induced by withdrawing blood from a femoral arterial catheter. The blood volume withdrawn was 40% of the total blood volume for group 1 and 30% for group 2 and 3. Group 3 was anesthetized with sodium pentobarbital (25 mg/kg, i.v.) at the beginning of blood withdrawal. Our data showed that the survival rate was 87.5% at 48 h in the conscious group and 0% at 9 h in anesthetic group after hemorrhage. The levels of mean arterial pressure, heart rate, white blood count, TNF-a, IL1-b, CPK, and LDH after blood withdrawal in the anesthetic group were generally lower than those in conscious groups. These results indicated that anesthetics significantly affected the physiology of experimental animals. The conscious, unrestrained and cumulative volume-controlled hemorrhagic shock model was a good experimental model to investigate the physical phenomenon without anesthetic interfernce.

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Section: Discussionmentioning

confidence: 89%

“…A recent study demonstrated that cumulative oxygen debt, arterial base excess and plasma lactate are superior predictors of outcome in comparison to such variables as the volume of blood loss, blood pressure and cardiac output [1,21]. The onset of hemorrhage is associated with a shift to metabolic acidosis.…”

Section: Discussionmentioning

confidence: 99%

The physiological changes of cumulative hemorrhagic shock in conscious rats

et al. 2006

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“…The most extensively studied is base deficit. It has been shown in animal and clinical studies of hemorrhagic shock that the severity of metabolic acidosis determined by this method correlates with a higher probability of death [67][68][69], as well as with a higher risk of multiple organ dysfunction syndrome [43,48]. The velocity of normalization of the base deficit has not been related with the prognosis.…”

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confidence: 99%

Critical Care Issues in the Early Management of Severe Trauma

García

2006

Surgical Clinics of North America

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Violent trauma and road traffic injuries kill more than 2.5 million people in the world every year. It has been calculated by the World Health Organization that in 2002 there occurred 1.6 million violent deaths [1] and 1.2 million deaths from traffic injury [2], for a combined mortality of 48 deaths per 100,000 population per year.Most trauma deaths occur at the scene or in the first hour after trauma, with a proportion from 34% to 50% occurring in hospitals [3]. These deaths could be prevented by optimization of trauma care. Preventability of trauma deaths has been reported as high as 76% [4] and as low as 1% in mature trauma systems [5,6].Prehospitalization procedures, elapsed time to hospital arrival are, of course, vital to the whole trauma scenario, but errors made in the in-hospital phase of care are responsible for one third to two thirds of the reported by different authors [7,8]. Of these, intensive care unit (ICU) errors are among the most frequent and significant. Errors in the ICU management of trauma patients were studied by Duke and colleagues [9]. They reported 165 ICU trauma deaths. Two hundred fifty-eight errors occurred in 81 patients (52%), and 134 of them contributed to death in 52 patients (34%). ICU errors were classified as management errors (82%), diagnostic (9%), technique (5%), and system inadequacies (4%). Davis and colleagues [10] identified critical care errors in 30% of 125 trauma deaths with errors. These errors contributed to 48% of all preventable deaths.The most common critical care errors are related to airway and respiratory management, fluid resuscitation, neurotrauma diagnosis and support, and delayed diagnosis of critical lesions [9,10].It is imperative for the general surgeon who takes care of trauma patients to know how to deal with these critical aspects, to reduce preventable morbidity and mortality. In the next segment, the situations in which the participation of the surgeon is crucial, during the initial phases of reanimation and stabilization of the critically traumatized patient will be discussed. Airway and ventilation managementAirway and respiratory management errors are the most common of those identified by several authors [9][10][11] The cardinal manifestation is a sudden or a rapidly progressing desaturation, frequently accompanied by tachycardia and arrhytmias, and occasionally by agitation. Hypertension announces the cardiovascular collapse, and bradicardia appears immediately after the total collapse [12]. The symptoms should not be attributed to agitation when it is present, and other possible causes must be ruled out before. Diagnosing the complication involves a directed physical examination, the analysis of the airway pressures and ventilator volumes, chest radiographs, and sometimes the measurement of arterial blood gases (ABG), and the urinary bladder pressure ( Table 1).The emergency conditions in which the access to the airways must be gained, the displacement to diagnosis areas or operating room and the agitation, often present, make the critical...

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“…The excess of lactate, as an indicator of the lack of oxygen, has been studied to evaluate the seriousness of the state of shock in humans and in experimental models 2,3 . It is considered a quite reliable parameter for shock intensity when comparing the measurements of arterial pressure and heart insufficiency 10,11 .…”

Section: Discussionmentioning

confidence: 99%

“…Because of low perfusion and tissue oxygenation, anaerobic metabolism develops and lactic acid is produced resulting in metabolic acidosis. Therefore, serum lactate has been used to evaluate the occurrence and intensity of tissue hypoperfusion 2,3 .…”

Section: Introductionmentioning

confidence: 99%

Hemorrhagic shock influence on colonic anastomoses in rats: evaluation of rupture by liquid distension resistance test

et al. 2008

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PURPOSE: To evaluate the effect of hemorrhagic shock in colonic anastomoses in rats, with a rupture by liquid distension resistance test. METHODS: Wistar lineage rats, averaging 90 days old and weighing from 310 to 380 grams were divided into two groups. In the first group (G1), 10 animals were submitted to colonic anastomoses in normovolemic terms and the second group (G2), of 10 animals, was submitted to colonic anastomoses in hypovolemic conditions. The shock was caused by half milliliter of blood withdrawn, every two minutes, until the value of average 50mmHg arterial pressure or a total volume corresponding 30% withdrawal of volemia was reached. Serum lactate dosages were carried out at the beginning and end of the procedure. The average serum lactate values at the end of the surgery were 1.91 mmol/l in G1 group and 3.69 mmol/l in G2 group (p<0.05). On the fifth postoperative day, the animals were euthanized. The anastomoses were evaluated with a rupture by liquid distension resistance test. RESULTS: In G1, the average value of colonic rupture was 160.7 mmHg whereas in G2 it was 152.1mmHg (p>0.05). CONCLUSION: Hemorrhagic shock, under the established conditions of this study, had no influence on colonic anastomoses in rats evaluated with the rupture by liquid distention resistance test.

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Oxygen debt and metabolic acidemia as quantitative predictors of mortality and the severity of the ischemic insult in hemorrhagic shock

Cited by 278 publications

References 0 publications

The physiological changes of cumulative hemorrhagic shock in conscious rats

The physiological changes of cumulative hemorrhagic shock in conscious rats

Critical Care Issues in the Early Management of Severe Trauma

Hemorrhagic shock influence on colonic anastomoses in rats: evaluation of rupture by liquid distension resistance test

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