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Hemorrhagic Shock: Blood Marker Sequencing and Pulmonary Gas Exchange

Background: The early identification of internal hemorrhage in critically ill patients may be difficult. Besides circulatory parameters, hemoglobin and lactate concentration, metabolic acidosis and hyperglycemia serve as laboratory markers for bleeding. In this experiment, we examined pulmonary gas...

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Autores principales: Treml, Benedikt, Kleinsasser, Axel, Knotzer, Johann, Breitkopf, Robert, Velik-Salchner, Corinna, Rajsic, Sasa
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9955920/
https://www.ncbi.nlm.nih.gov/pubmed/36832127
http://dx.doi.org/10.3390/diagnostics13040639
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author Treml, Benedikt
Kleinsasser, Axel
Knotzer, Johann
Breitkopf, Robert
Velik-Salchner, Corinna
Rajsic, Sasa
author_facet Treml, Benedikt
Kleinsasser, Axel
Knotzer, Johann
Breitkopf, Robert
Velik-Salchner, Corinna
Rajsic, Sasa
author_sort Treml, Benedikt
collection PubMed
description Background: The early identification of internal hemorrhage in critically ill patients may be difficult. Besides circulatory parameters, hemoglobin and lactate concentration, metabolic acidosis and hyperglycemia serve as laboratory markers for bleeding. In this experiment, we examined pulmonary gas exchange in a porcine model of hemorrhagic shock. Moreover, we sought to investigate if a chronological order of appearance regarding hemoglobin, lactatemia, standard base excess/deficit (SBED) and hyperglycemia exists in early severe hemorrhage. Methods: In this prospective, laboratory study, twelve anesthetized pigs were randomly allocated to exsanguination or a control group. Animals in the exsanguination group (n = 6) endured a 65% blood loss over 20 min. No intravenous fluids were administered. Measurements were taken before, immediately after, and at 60 min after the completed exsanguination. Measurements included pulmonary and systemic hemodynamic variables, hemoglobin concentration, lactate, base excess (SBED), glucose concentration, arterial blood gases, and a multiple inert gas assessment of pulmonary function. Results: At baseline, variables were comparable. Immediately after exsanguination, lactate and blood glucose were increased (p = 0.001). The arterial partial pressure of oxygen was increased at 60 min after exsanguination (p = 0.04) owing to a decrease in intrapulmonary right-to-left shunt and less ventilation-perfusion inequality. SBED was different to the control only at 60 min post bleeding (p < 0.001). Hemoglobin concentration did not change at any time (p = 0.97 and p = 0.14). Conclusions: In experimental shock, markers of blood loss became positive in chronological order: lactate and blood glucose concentrations were raised immediately after blood loss, while changes in SBED lagged behind and became significant one hour later. Pulmonary gas exchange is improved in shock.
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spelling pubmed-99559202023-02-25 Hemorrhagic Shock: Blood Marker Sequencing and Pulmonary Gas Exchange Treml, Benedikt Kleinsasser, Axel Knotzer, Johann Breitkopf, Robert Velik-Salchner, Corinna Rajsic, Sasa Diagnostics (Basel) Article Background: The early identification of internal hemorrhage in critically ill patients may be difficult. Besides circulatory parameters, hemoglobin and lactate concentration, metabolic acidosis and hyperglycemia serve as laboratory markers for bleeding. In this experiment, we examined pulmonary gas exchange in a porcine model of hemorrhagic shock. Moreover, we sought to investigate if a chronological order of appearance regarding hemoglobin, lactatemia, standard base excess/deficit (SBED) and hyperglycemia exists in early severe hemorrhage. Methods: In this prospective, laboratory study, twelve anesthetized pigs were randomly allocated to exsanguination or a control group. Animals in the exsanguination group (n = 6) endured a 65% blood loss over 20 min. No intravenous fluids were administered. Measurements were taken before, immediately after, and at 60 min after the completed exsanguination. Measurements included pulmonary and systemic hemodynamic variables, hemoglobin concentration, lactate, base excess (SBED), glucose concentration, arterial blood gases, and a multiple inert gas assessment of pulmonary function. Results: At baseline, variables were comparable. Immediately after exsanguination, lactate and blood glucose were increased (p = 0.001). The arterial partial pressure of oxygen was increased at 60 min after exsanguination (p = 0.04) owing to a decrease in intrapulmonary right-to-left shunt and less ventilation-perfusion inequality. SBED was different to the control only at 60 min post bleeding (p < 0.001). Hemoglobin concentration did not change at any time (p = 0.97 and p = 0.14). Conclusions: In experimental shock, markers of blood loss became positive in chronological order: lactate and blood glucose concentrations were raised immediately after blood loss, while changes in SBED lagged behind and became significant one hour later. Pulmonary gas exchange is improved in shock. MDPI 2023-02-09 /pmc/articles/PMC9955920/ /pubmed/36832127 http://dx.doi.org/10.3390/diagnostics13040639 Text en © 2023 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Treml, Benedikt
Kleinsasser, Axel
Knotzer, Johann
Breitkopf, Robert
Velik-Salchner, Corinna
Rajsic, Sasa
Hemorrhagic Shock: Blood Marker Sequencing and Pulmonary Gas Exchange
title Hemorrhagic Shock: Blood Marker Sequencing and Pulmonary Gas Exchange
title_full Hemorrhagic Shock: Blood Marker Sequencing and Pulmonary Gas Exchange
title_fullStr Hemorrhagic Shock: Blood Marker Sequencing and Pulmonary Gas Exchange
title_full_unstemmed Hemorrhagic Shock: Blood Marker Sequencing and Pulmonary Gas Exchange
title_short Hemorrhagic Shock: Blood Marker Sequencing and Pulmonary Gas Exchange
title_sort hemorrhagic shock: blood marker sequencing and pulmonary gas exchange
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9955920/
https://www.ncbi.nlm.nih.gov/pubmed/36832127
http://dx.doi.org/10.3390/diagnostics13040639
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