Ozone Improves Oxygenation and Offers Organ Protection after Autologous Blood Transfusion in a Simulated Carbon Dioxide Pneumoperitoneal Environment in a Rabbit Hemorrhagic Shock Model

Abstract

<b><i>Objectives:</i></b> Autologous blood transfusion techniques are well applied in surgery, but the red blood cells (RBCs) collected during laparoscopic surgery may forfeit their ability to oxygenate. O<sub>3</sub> is a potent oxidation gas. This study investigates whether O<sub>3</sub> could improve the oxygen-carrying capacity of RBCs, reduce inflammatory reactions, and offer organ protection. <b><i>Methods:</i></b> We established a hemorrhagic shock model in rabbits, and simulated CO<sub>2</sub> pneumoperitoneum and O<sub>3</sub> were applied before autologous blood transfusion. Perioperative mean arterial pressure and arterial blood gas were recorded, blood gas and RBC morphology of collected blood were analyzed, plasma IL-6, ALT, AST, CRE, and lung histopathology POD0 and POD3 were tested, as well as postoperative survival quality. <b><i>Results:</i></b> Autologous blood that underwent simulated CO<sub>2</sub> pneumoperitoneum had a lower pH and SaO<sub>2</sub> and a higher PaCO<sub>2</sub> than the control group. After O<sub>3</sub> treatment, PaO<sub>2</sub> and SaO<sub>2</sub> increased significantly, with unchanged pH values and PaCO<sub>2</sub>. RBCs in autologous blood were drastically deformed after CO<sub>2</sub> conditioning and then reversed to normal by O<sub>3</sub> treatment. Rabbits that received CO<sub>2</sub>-conditioned autologous blood had a compromised survival quality after surgery, higher plasma IL-6 levels, higher lung injury scores on POD0, higher ALT and AST levels on POD3, and O<sub>3</sub> treatment alleviated these adverse outcomes. <b><i>Conclusion:</i></b> O<sub>3</sub> can restore RBC function, significantly improve blood oxygenation under simulated CO<sub>2</sub> pneumoperitoneum, offer organ protection, and improve the postoperative survival quality in the rabbit hemorrhage shock model.