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Systemic and microcirculatory effects of blood transfusion in experimental hemorrhagic shock
BACKGROUND: The microvascular reperfusion injury after retransfusion has not been completely characterized. Specifically, the question of heterogeneity among different microvascular beds needs to be addressed. In addition, the identification of anaerobic metabolism is elusive. The venoarterial PCO(2...
Autores principales: | , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Springer International Publishing
2017
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5400770/ https://www.ncbi.nlm.nih.gov/pubmed/28432665 http://dx.doi.org/10.1186/s40635-017-0136-3 |
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author | Ferrara, Gonzalo Edul, Vanina S. Kanoore Canales, Héctor S. Martins, Enrique Canullán, Carlos Murias, Gastón Pozo, Mario O. Caminos Eguillor, Juan F. Buscetti, María G. Ince, Can Dubin, Arnaldo |
author_facet | Ferrara, Gonzalo Edul, Vanina S. Kanoore Canales, Héctor S. Martins, Enrique Canullán, Carlos Murias, Gastón Pozo, Mario O. Caminos Eguillor, Juan F. Buscetti, María G. Ince, Can Dubin, Arnaldo |
author_sort | Ferrara, Gonzalo |
collection | PubMed |
description | BACKGROUND: The microvascular reperfusion injury after retransfusion has not been completely characterized. Specifically, the question of heterogeneity among different microvascular beds needs to be addressed. In addition, the identification of anaerobic metabolism is elusive. The venoarterial PCO(2) to arteriovenous oxygen content difference ratio (P(v-a)CO(2)/C(a-v)O(2)) might be a surrogate for respiratory quotient, but this has not been validated. Therefore, our goal was to characterize sublingual and intestinal (mucosal and serosal) microvascular injury after blood resuscitation in hemorrhagic shock and its relation with O(2) and CO(2) metabolism. METHODS: Anesthetized and mechanically ventilated sheep were assigned to stepwise bleeding and blood retransfusion (n = 10) and sham (n = 7) groups. We performed analysis of expired gases, arterial and mixed venous blood gases, and intestinal and sublingual videomicroscopy. RESULTS: In the bleeding group during the last step of hemorrhage, and compared to the sham group, there were decreases in oxygen consumption (3.7 [2.8–4.6] vs. 6.8 [5.8–8.0] mL min(−1) kg(−1), P < 0.001) and increases in respiratory quotient (0.96 [0.91–1.06] vs. 0.72 [0.69–0.77], P < 0.001). Retransfusion normalized these variables. The P(v-a)CO(2)/C(a-v)O(2) increased in the last step of bleeding (2.4 [2.0–2.8] vs. 1.1 [1.0–1.3], P < 0.001) and remained elevated after retransfusion, compared to the sham group (1.8 [1.5–2.0] vs. 1.1 [0.9–1.3], P < 0.001). P(v-a)CO(2)/C(a-v)O(2) had a weak correlation with respiratory quotient (Spearman R = 0.42, P < 0.001). All the intestinal and sublingual microcirculatory variables were affected during hemorrhage and improved after retransfusion. The recovery was only complete for intestinal red blood cell velocity and sublingual total and perfused vascular densities. CONCLUSIONS: Although there were some minor differences, intestinal and sublingual microcirculation behaved similarly. Therefore, sublingual mucosa might be an adequate window to track intestinal microvascular reperfusion injury. Additionally, P(v-a)CO(2)/C(a-v)O(2) was poorly correlated with respiratory quotient, and its physiologic behavior was different. Thus, it might be a misleading surrogate for anaerobic metabolism. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s40635-017-0136-3) contains supplementary material, which is available to authorized users. |
format | Online Article Text |
id | pubmed-5400770 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2017 |
publisher | Springer International Publishing |
record_format | MEDLINE/PubMed |
spelling | pubmed-54007702017-05-08 Systemic and microcirculatory effects of blood transfusion in experimental hemorrhagic shock Ferrara, Gonzalo Edul, Vanina S. Kanoore Canales, Héctor S. Martins, Enrique Canullán, Carlos Murias, Gastón Pozo, Mario O. Caminos Eguillor, Juan F. Buscetti, María G. Ince, Can Dubin, Arnaldo Intensive Care Med Exp Research BACKGROUND: The microvascular reperfusion injury after retransfusion has not been completely characterized. Specifically, the question of heterogeneity among different microvascular beds needs to be addressed. In addition, the identification of anaerobic metabolism is elusive. The venoarterial PCO(2) to arteriovenous oxygen content difference ratio (P(v-a)CO(2)/C(a-v)O(2)) might be a surrogate for respiratory quotient, but this has not been validated. Therefore, our goal was to characterize sublingual and intestinal (mucosal and serosal) microvascular injury after blood resuscitation in hemorrhagic shock and its relation with O(2) and CO(2) metabolism. METHODS: Anesthetized and mechanically ventilated sheep were assigned to stepwise bleeding and blood retransfusion (n = 10) and sham (n = 7) groups. We performed analysis of expired gases, arterial and mixed venous blood gases, and intestinal and sublingual videomicroscopy. RESULTS: In the bleeding group during the last step of hemorrhage, and compared to the sham group, there were decreases in oxygen consumption (3.7 [2.8–4.6] vs. 6.8 [5.8–8.0] mL min(−1) kg(−1), P < 0.001) and increases in respiratory quotient (0.96 [0.91–1.06] vs. 0.72 [0.69–0.77], P < 0.001). Retransfusion normalized these variables. The P(v-a)CO(2)/C(a-v)O(2) increased in the last step of bleeding (2.4 [2.0–2.8] vs. 1.1 [1.0–1.3], P < 0.001) and remained elevated after retransfusion, compared to the sham group (1.8 [1.5–2.0] vs. 1.1 [0.9–1.3], P < 0.001). P(v-a)CO(2)/C(a-v)O(2) had a weak correlation with respiratory quotient (Spearman R = 0.42, P < 0.001). All the intestinal and sublingual microcirculatory variables were affected during hemorrhage and improved after retransfusion. The recovery was only complete for intestinal red blood cell velocity and sublingual total and perfused vascular densities. CONCLUSIONS: Although there were some minor differences, intestinal and sublingual microcirculation behaved similarly. Therefore, sublingual mucosa might be an adequate window to track intestinal microvascular reperfusion injury. Additionally, P(v-a)CO(2)/C(a-v)O(2) was poorly correlated with respiratory quotient, and its physiologic behavior was different. Thus, it might be a misleading surrogate for anaerobic metabolism. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s40635-017-0136-3) contains supplementary material, which is available to authorized users. Springer International Publishing 2017-04-21 /pmc/articles/PMC5400770/ /pubmed/28432665 http://dx.doi.org/10.1186/s40635-017-0136-3 Text en © The Author(s). 2017 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. |
spellingShingle | Research Ferrara, Gonzalo Edul, Vanina S. Kanoore Canales, Héctor S. Martins, Enrique Canullán, Carlos Murias, Gastón Pozo, Mario O. Caminos Eguillor, Juan F. Buscetti, María G. Ince, Can Dubin, Arnaldo Systemic and microcirculatory effects of blood transfusion in experimental hemorrhagic shock |
title | Systemic and microcirculatory effects of blood transfusion in experimental hemorrhagic shock |
title_full | Systemic and microcirculatory effects of blood transfusion in experimental hemorrhagic shock |
title_fullStr | Systemic and microcirculatory effects of blood transfusion in experimental hemorrhagic shock |
title_full_unstemmed | Systemic and microcirculatory effects of blood transfusion in experimental hemorrhagic shock |
title_short | Systemic and microcirculatory effects of blood transfusion in experimental hemorrhagic shock |
title_sort | systemic and microcirculatory effects of blood transfusion in experimental hemorrhagic shock |
topic | Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5400770/ https://www.ncbi.nlm.nih.gov/pubmed/28432665 http://dx.doi.org/10.1186/s40635-017-0136-3 |
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