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Author(s) -
Staib, A,
Collier, J,
Fung, Yoke Lin,
Do, H L,
Thom, Ogilvie,
Dunster, K,
Fraser, J F
Publication year - 2012
Publication title -
emergency medicine australasia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.602
H-Index - 52
eISSN - 1742-6723
pISSN - 1742-6731
DOI - 10.1111/j.1742-6723.2012.01521.x
Subject(s) - medicine , citation , library science , family medicine , computer science
Haemorrhagic shock management is aimed at improving end organ tissue perfusion and oxygenation. Until recently, studies have relied on global, surrogate markers of tissue oxygenation, or overall morbidity and mortality. Although important, these studies are complicated by multiple confounding variables, and do not look directly at the presumed site of the pathology-the end organ tissue itself. The development of combined microprobe technology and advanced multichannel monitoring provides us the opportunity to directly measure oxygenation and microvascular fl ow at the end organ tissue level. Objective: To directly assess the real-time changes in tissue oxygenation in key organs, whilst simultaneously assessing typical global markers of resuscitation in sheep being resuscitated from severe (class 4) haemorrhagic shock. To monitor the sustained effect of resuscitation with normal saline or albumin on haemodynamics, tissue oxygenation and perfusion indices in the post-resuscitation period. Methods: Under full anaesthesia, controlled haemorrhage of 30% total blood volume was affected in 11 sheep. Mean arterial pressure was reduced to below 40 mmHg and this was maintained for 30 mins. Sheep were instrumented to allow monitoring of continuous cardiac output, central venous oxygenation and arterial blood gas status. Direct tissue oxymetry was measured directly and continuously monitored in the brain, skeletal muscle and renal cortex using combined tissue oxymeters and perfusion probes. Sheep were then resuscitated with either normal saline or albumin in equivalent volumes. They were then monitored for 4 hours post resuscitation. Findings: Graphic representation of: Renal perfusion and oxygenation, brain perfusion and oxygenation, skeletal muscle perfusion and oxygenation with minutely vitals/cardiac output, oxygen delivery etc/tissue O2 from 15 min before haemorrhage to half hour post transfusion for each group (saline and albumin) Conclusions: Saline is at least as effective as albumin in improving end organ oxygenation and perfusion in haemorrhagic shock management