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Detection of organ ischemia during hemorrhagic shock
Author(s) -
Kvarstein G.,
Mirtaheri P.,
Tønnessen T. I.
Publication year - 2003
Publication title -
acta anaesthesiologica scandinavica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.738
H-Index - 107
eISSN - 1399-6576
pISSN - 0001-5172
DOI - 10.1034/j.1399-6576.2003.00134.x
Subject(s) - medicine , anaerobic exercise , renal blood flow , blood flow , kidney , pco2 , cardiac output , skeletal muscle , hemodynamics , concomitant , endocrinology , small intestine , shock (circulatory) , cardiology , physiology
Background: In a porcine hemorrhagic shock model we aimed to determine: (a) whether blood flow to the intestine and kidney was more reduced than cardiac output; (b) whether parameters of anaerobic metabolism correlated with regional blood flow; and (c) whether metabolic parameters in intestine, kidney and skeletal muscles detected a compromized metabolic state at an earlier stage than did systemic parameters. Methods: In an animal research laboratory at a university hospital six domestic pigs were subjected to volume‐controlled hemorrhage. Every 30 min samples of blood were withdrawn. Systemic and regional hemodynamic parameters and tissue levels of PCO 2 were monitored. Whole body and organ‐specific oxygen consumption (VO 2 ) and veno‐arterial (VA) differences of lactate, glucose, potassium (K + ), PCO 2 , H + and base excess (BE) were calculated every 30 min. Results: With progressive hemorrhage, intestinal blood flow decreased to the same extent as cardiac output, whereas the reduction in renal blood flow was more pronounced. We found a concomitant reduction in VO 2 (onset of supply dependent metabolism) in intestine, kidney and skeletal muscles. In muscular tissue PCO 2 increased to levels three times higher than baseline, while renal and intestinal PCO 2 increased eightfold. Supply dependency was associated with a concomitant increase in VA CO 2 and VA H + . Also, VA lactate increased, mostly in intestine and least in skeletal muscle. Intestinal and renal VA K + increased, while muscular VA K + decreased. Arterial lactate and H + increased considerably, whereas arterial BE decreased. Conclusion: With progressive hemorrhage, renal blood flow, but not intestinal and skeletal muscle blood flow, was reduced more than cardiac output. Supply dependent oxygen metabolism (VO 2 ) and organ acidosis occurred simultaneously in the three organs, despite differences in blood flow reductions. Organ ischemia coincided with a pronounced change in arterial lactate and systemic acid base parameters.