2017
DOI: 10.1177/1535370217694099
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The physiology of blood loss and shock: New insights from a human laboratory model of hemorrhage

Abstract: Hemorrhage is the leading cause of death in both civilian and military trauma. The work submitted in this review is important because it advances the understanding of mechanisms that contribute to the total integrated physiological compensations for inadequate tissue oxygenation (i.e. shock) that arise from hemorrhage. Unlike an animal model, we introduce the utilization of lower body negative pressure as a noninvasive model that allows for the study of progressive reductions in central blood volume similar to… Show more

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Cited by 71 publications
(107 citation statements)
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References 29 publications
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“…The CRM has proven to be an earlier as well as more sensitive and specific indicator of compromised physiological status under conditions of reduced central blood volume than blood pressure, SpO 2 , heart rate, shock index, radial pulse character, end‐tidal CO 2 , respiratory rate, Glasgow Coma Score, blood pH, blood lactate, peripheral perfusion index, pulse pressure variability, and tissue oxygen, in both human experimentation and trauma patients . The superior sensitivity of the CRM is reflected by earlier changes in CRM when compared to various standard vital signs while its specificity emerges from the capability that the algorithm has “learned” to distinguish individuals who compensate well to hemorrhage from those who do not . Among other labels, these populations can be defined as “Good Compensators” who make up about two‐thirds of individuals while the remaining one‐third comprises “Poor Compensators” (Fig.…”
Section: Mesauring the Crmentioning
confidence: 99%
“…The CRM has proven to be an earlier as well as more sensitive and specific indicator of compromised physiological status under conditions of reduced central blood volume than blood pressure, SpO 2 , heart rate, shock index, radial pulse character, end‐tidal CO 2 , respiratory rate, Glasgow Coma Score, blood pH, blood lactate, peripheral perfusion index, pulse pressure variability, and tissue oxygen, in both human experimentation and trauma patients . The superior sensitivity of the CRM is reflected by earlier changes in CRM when compared to various standard vital signs while its specificity emerges from the capability that the algorithm has “learned” to distinguish individuals who compensate well to hemorrhage from those who do not . Among other labels, these populations can be defined as “Good Compensators” who make up about two‐thirds of individuals while the remaining one‐third comprises “Poor Compensators” (Fig.…”
Section: Mesauring the Crmentioning
confidence: 99%
“…Severe blood loss leading to systemic hypoxia results in irreversible lethal damage of tissues and organs. The systemic response to blood loss acts to maintain levels of arterial pressure (AP) necessary to provide adequate perfusion pressure (PP) for sufficient oxygen delivery (Gutierrez et al 2004;Moore 2014;Schiller et al 2017). At early stages of hemorrhage, decreased AP and blood volume activate peripheral and central baro-and volumo-receptors and trigger compensatory sympathetic and endocrine mechanisms (Bonnano 2011).…”
Section: Pathophysiology Of Hemorrhagic Shockmentioning
confidence: 99%
“…During hemorrhage, physiological compensation may maintain tissue perfusion [4], but the compensatory response to blood loss and time course for development of shock is largely affected by the individual characteristics of the patient. Adjustments within the venous system are critical for maintaining venous pressure during hemorrhage, and mobilization of unstressed blood volume has been characterized as the predominant and most effective mechanism in preserving venous return and thus cardiac output (CO) [5].…”
Section: Introductionmentioning
confidence: 99%