journal laveccs 11.pdf

8/10/2019 Journal Laveccs 11.pdf

1/3

14/03/12 20:07ournal Laveccs

Pgina 1 de 3http://www.journal.laveccs.org/full.php?id=294

Home

InicioDerechos de CopyrightEquipo EditorialInstrucciones para autoresContacto

Journals

Ver Journal

Laveccs.org

HomeCursos abc LAVECCS

Zona sociosBiblioteca pblicaBiblioteca para socios

Afiliarse a LAVECCSContacto LAVECCSForo

Journal Latinoamericano de Medicina Veterinaria de Emergencia y CuidadosIntensivos

Use of Vasopressors and Whole Blood in Hemorrhagic Shock in Swine

Autor: Martins,A.R.C1*; Voorwald, F2; Nani, R.S3; Rocha Filho, J.A3

1 - PhD student in anesthesiology at FM-USP2 - PhD student in surgery at UNESP-Jaboticabal3 - Medical Research at Medical Research Laboratory of Liver Transplantation, FM-USP.

*[email protected]

JLAVECC ISSN 1688-6100 3(3) 2011, pp 261-265

Fecha: 2011-08-01 volver

Resmenes Comunicaciones Cientficas y Casos Clnicos en Medicina de Emergencia y Cuidados Intensivos en Animales deCompaa presentados en el 4 Congreso Latinoamericano de Emergencias y Cuidados Intensivos, LAVECCS

Abstract

Hemorrhagic shock (HS) is the second leading cause of early mortality in trauma, accounting for 40% ofdeaths. The ideal strategy for resuscitation in HS is yet undetermined but it is recognized that thisshould include the prevention of cardiac arrest, the progression to refractory shock and rescue of prolongedshock1-3. Patients with HS are exposed to pathophysiologic processes and therapeutic interventions,particularly blood transfusion, that may predispose to hyperkalemia (hiperK), one of the most lethal electrolytedisturbances4. The aim of the study was to compare the hemodynamic and microcirculatory states after usinga rapid infusion of whole blood associated with vasopressors.The conclusion of this experimental work was that blood transfusion should be administered at a low constantrate in order to prevent an acute increase of blood K. Moreover, both whole blood and vasopressors areindicated to prevent the harmful effects of HS over the organs.

Material and Methods

Twelve pigs were anesthetized and mechanically ventilated whose were submitted to surgical resection of theliver or for autologous transplant, the animals selected for this study were the ones that presented hemorrhagicshock. The shock was determined by the following criteria: blood loss !40% of total blood volume, centralvenous oxygen saturation (SvO2)


2/3



complication. The hiperK can't be seen in those who die early during resuscitation, as well as thosewho regresses immediately resuscitation is successful, as demonstrated by some studies6.

Parameter Group T0 T1 T2 T3 T4CO (L/min) G1

G23.6 0.44.0 0.4

1.3 0.31.5 0.5

3.2 0.23.5 0.3

3. 0 0.43.0 0.4

3.3 0.11.1 0.2*a

MAP (mmHg) G1G2

86 1084 8

48 1044 5

90 586 4

88 680 3

85 840 4*a

SVO 2 (%) G1G2

75 3.073 3

58 557 3

78 172 2

76 165 4a

75 289 1*a

PAP (mmHg G1G2

18 220 3

8 310 2

29 428 4

29 518 4a

30 59 2*a

K (mmol/L) G1G2

3.5 0.44.0 0.2

4.0 0.34.3 0.3

3.8 0.25.0 0.1a

3.9 0.16.1 0.8a

3.7 0.17.3 0.3*a

Lactate (mg/dL) G1G2

19 820 10

47 850 8

40 345 6

35 547 3a

34 360 5*a

Table 1. Hemodynamic and metabolic parameters (meansd); CO: cardiac output; MAP: mean arterial pressure; SvO2: mixedvenous oxygen saturation; PAP: pulmonary artery pressure; K: potassium; *: different from T0; : different from T2; : differentfrom T3; a: different from group G1; p


3/3



so indicadas para evitar as consequncias do CH sobre os rgos.

Referencias 1. Liberman M, Roudsari BS. Prehospital trauma care: what do we really know? Curr Opin Crit Care2007;13:691-696;2. Peruski AM, Cooper ES. Assessment of microcirculatory changes by use of sidestream dark fieldmicroscopy during hemorrhagic shock in dogs.Am J Vet Res2011;72:438-445;3. Moochhala S, Wu J, Lu J. Hemorrhagic shock: an overview of animal models. Front Biosci 2009;14:4631-4639;

4. Hall TL, Barnes A, Miller JR, et al. Neonatal mortality following transfusion of red cells with high plasmapotassium levels. Transfusion1993;33:606-609; 5.Brown KA, Bissonnette B, MacDonald M, et al. Hyperkalaemia during massive blood transfusion inpaediatric craniofacial surgery. Can J Anaesth1990;37:401-408;6.Rocha Filho JA, Nani RS, D'Albuquerque LA, et al. Hyperkalemia accompanies hemorrhagic shock andcorrelates with mortality. Clinics (Sao Paulo)2009;64:591-597.

volver

2009 - LAVECCS.ORG | Derechos Reservados Diseo:365diasonline.com

journal laveccs 11.pdf

Documents