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Am J Physiol Heart Circ Physiol 276: H2035-H2043, 1999;
0363-6135/99 $5.00
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Vol. 276, Issue 6, H2035-H2043, June 1999

Systemic and microcirculatory effects of autologous whole blood resuscitation in severe hemorrhagic shock

Heinz Kerger1, Klaus F. Waschke1, Klaus V. Ackern1, Amy G. Tsai2, and Marcos Intaglietta2

1 Department of Anesthesiology and Operative Critical Care Medicine, Faculty of Clinical Medicine Mannheim, University of Heidelberg, D-68135 Mannheim, Germany; and 2 Department of Bioengineering, University of California San Diego, La Jolla, California 92093

Systemic and microcirculatory effects of autologous whole blood resuscitation after 4-h hemorrhagic shock with a mean arterial pressure (MAP) level of 40 mmHg were investigated in 63 conscious Syrian golden hamsters. Microcirculation of skeletal skin muscle and subcutaneous connective tissue was visualized in a dorsal skinfold. Shed blood was retransfused within 30 min after 4 h. Animals were grouped into survivors in good (SG) and poor condition (SP) and nonsurvivors (NS) according to 24-h outcome after resuscitation and studied before shock, during shock (60, 120, and 240 min), and 30 min and 24 h after resuscitation. Microvascular and interstitial PO2 values were determined by phosphorescence decay. Shock caused a significant increase of arterial PO2 and decrease of PCO2, pH, and base excess. In the microcirculation, there was a significant decrease in blood flow (QB), functional capillary density (FCD; capillaries with red blood cell flow), and interstitial PO2 [1.8 ± 0.8 mmHg (SG), 1.3 ± 1.3 mmHg (SP), and 0.9 ± 1.1 mmHg (NS) vs. 23.0 ± 6.1 mmHg at control]. Blood resuscitation caused immediate MAP recompensation in all animals, whereas metabolic acidosis, hyperventilation, and a significant interstitial PO2 decrease (40-60% of control) persisted. In NS (44.4% of the animals), systemic and microcirculatory alterations were significantly more severe both in shock and after resuscitation than in survivors. Whereas in SG (31.8% of the animals) there was only a slight (15-30%) but still significant impairment of microscopic tissue perfusion (QB, FCD) and oxygenation at 24 h, SP (23.8% of the animals) showed severe metabolic acidosis and substantial decreases (>= 50%) of FCD and interstitial PO2. FCD, interstitial PO2, and metabolic state were the main determinants of shock outcome.

microcirculation; autologous blood; partial pressure of oxygen; functional capillary density; base excess; phosphorescence decay


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