Plasma volume expansion with solutions of hemoglobin, albumin, and Ringer lactate in sheep

Abstract

We have measured plasma volume expansion (Evans blue and hematocrit changes) and hemodynamic responses in conscious hemorrhaged and normovolemic splenectomized sheep after a 30-min infusion of either 20 ml/kg of diaspirin cross-linked hemoglobin (DCLHb), 20 ml/kg of human albumin (Alb), or 60 ml/kg of a solution of Ringer lactate (RL). All regimens expanded blood volume and increased blood pressure and cardiac output after hemorrhage. However, only 15 ± 3% of the infused volume of RL was evident as intravascular expansion 10-min postinfusion, compared with 67 ± 16% and 139 ± 139% for Alb and DCLHb, respectively. DCLHb infusions were associated with higher blood pressures and lower cardiac outputs compared with RL and Alb infusions, but the increased oxygen content of blood with DCLHb resulted in systemic delivery of oxygen similar to that of the other infusions. These differences in hemodynamics and vascular volume continued for 6 h, and at 24 h vascular volume and all hemodynamics were similar in all three groups. The better volume expansion with DCLHb may be due to greater mobilization of endogenous interstitial protein or reduced transcapillary loss as total intravascular endogenous plasma protein increased after infusion of DCLHb, whereas there was an apparent loss of endogenous intravascular protein after infusions of Alb and RL. Vasoconstriction by DCLHb is one mechanism that could lower blood-to-tissue transport of fluid and protein. In addition to its oxygen-carrying capacity and vasoactivity, DCLHb is associated with volume expansion properties out of proportion to its colloid osmotic pressure.

Arterial oxygenation and oxygen delivery after hemoglobin-based oxygen carrier infusion in canine hypovolemic shock: A dose-response study

“…3). These findings correlate well with effects of 10% diaspirin cross-linked Hb (P 50 : 33 torr; COP: 43 torr) in swine and sheep hemorrhagic shock models (32,39) and further support the idea that HBOCs with vasoconstrictive properties and high COP may expand plasma volume out of proportion to their colloid osmotic pressure, thereby limiting their efficacy in improving oxygen delivery to tissue (39).…”

Hemodynamic response and oxygen transport in pigs resuscitated with maleimide-polyethylene glycol-modified hemoglobin (MP4)

“…The primary result of these studies demonstrates that formulations of MalPEG-Hb did not promote an increase in systemic vascular resistance, a direct measure of vasoconstriction, in contrast to numerous reports with other formulations of cellfree Hb (4,6,19,35). SFH, used as a control solution, produced a greater rise in systemic and pulmonary vascular resistance and was, therefore, less effective in satisfying tissue O 2 demands as demonstrated by significantly less correction in BE and lactic acid after resuscitation.…”

Hemoglobin-Based Oxygen Carrier Distribution Inside Vascular Wall and Arterial Pressure Evolution: Is There a Relationship?

“…Fischer et al [36] showed that MAP rose signifi cantly above baseline at 10 min after resuscitation in the DCLHb-treated animals. The elevated pressures with HBOC were most likely due to Hb causing a generalized vasoconstriction due to binding of NO [37] , possibly after rapid extravasation or penetration of HBOC in artery walls [38] .…”