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Abstract
Introduction
In this study we evaluated effects of blood (B; n = 7), gelatine (G; n = 8) and Ringer's
lactate (R; n = 8) resuscitation on jejunal microvascular blood flow (PU), tissue
microvascular hemoglobin oxygen saturation (HbO2t) and jejunal mucosal tissue oxygen
tension (PO2muc) after severe haemorrhage (50% of estimated blood volume) in pigs.
Methods
Animals were anaesthetised, paralysed, and normoventilated. A small segment of the
jejunal mucosa was exposed by midline laparotomy and antimesenteric incision. PO2muc
was measured using Clark-type surface oxygen electrodes. HbO2t and PU were determined
by tissue reflectance spectrophotometry and laser doppler velocimetry. Systemic hemodynamics,
mesentericvenous acid base and blood gas variables as well as systemic acid base and
blood gas variables were recorded. Measurements were performed after a resting period,
after a 50 min period of haemorrhage (H) and after resuscitation with B, G and R to
achieve baseline pulmonary capillary wedge pressures at 70, 90, 110 and 130 min, respectively.
ANOVA was performed to analyse differences in mean values between and within groups.
Multiple comparisons were done by two tailed Dunnett's t-test followed by Bonferoni
correction. P ≤ 0.05 was considered significant. Data are presented as means ± SD.
Results
H resulted in significant hypotension and decreased systemic blood flow which was
reversed after resuscitation in all groups. At baseline we observed no differences
in PO2muc (B: 29± 5.9 mmHg), HbO2t (B: 48.5 ± 6.7%) and microvascular blood flow (B:
253 ± 66 PU) between groups. H equally and significantly decreased PU, PO2muc and
HbO2t in B, G, R animals. However, after resuscitation R animals had significantly
lower HbO2t (time point 130 min; R: 25 ± 9%) when compared with B and G animals (time
point 130 min; B: 39 ± 9%; G: 33 ± 10%). PO2muc decreased similar in B and R animals
after resuscitation (time point 130 min; B: 15 ± 6 mmHg; R 14 ± 7 mmHg). However,
in G animals a trend towards higher PO2muc values (time point 130 min; G: 20 ± 9 mmHg)
was observed during resuscitation. There were no differences concerning microvascular
blood flow during resuscitation.
Conclusion
Resuscitation after severe haemorrhage using whole blood, Ringer's lactate or gelatine
results in distinct changes of jejunal tissue oxygen supply. Whole blood resuscitation
favourably preserved HbO2t without affecting PO2muc while use of gelatine only, demonstrated
a trend towards higher PO2muc values when compared with R and B animals. Therefore
type of resuscitation fluid seems to have some impact on tissue oxygen supply within
the gastrointestinal tract.
Supported by a Lorenz Böhler Fonds 2000
[1
]Division of General and Surgical Intensive Care Medicine, Department of Anaesthesia
and Critical Care Medicine, University of Innsbruck, Anichstraβe 35, A-6020 Innsbruck,
Austria
Article
Publisher ID:
cc1634
DOI: 10.1186/cc1634
PMC ID: 3333593
SO-VID: ad9fff64-f210-4cfa-bdd5-67cc3aedd2d2
Conference name:
22nd International Symposium on Intensive Care and Emergency Medicine