RESUSCITATION OF PULMONARY CONTUSION - EFFECTS OF A RED-CELL SUBSTITUTE

Objective: To determine the impact of a vasoactive red cell substitute , diaspirin cross-linked hemoglobin, on respiratory derangements after traumatic lung injury. Design: Randomized, controlled animal experime nt, Setting: Large-animal laboratory, Subjects: Mechanically ventilate d, anesthetized young Yorkshire male swine (15 to 20 kg), Intervention s: Pigs(n = 6/group) received two pneumatic blasts to the right thorac ic cage at baseline, were hemorrhaged 30 mL/kg from t = 0 to 20 mins, resuscitated with 0.9% saline (group 1, 90 mL/kg) or diaspirin cross l inked hemoglobin (group 2, 15 mL/kg) from t = 20 to 40 mins, and then observed to t = 240 mins, Measurements and Main Results: Serial pulmon ary and systemic hemodynamic measurements, total thoracic compliance a ssessment, spiral three-dimensional computed tomography scan, and lung weights (n = 3/group) were used to assess lesion size and lung water. Mean arterial pressure was restored in both animal groups, Mean pulmo nary arterial pressure was significantly higher after resuscitation in animals receiving the red cell substitute. Oxygenation worsened mildl y in both groups. Compliance diminished in both groups but was signifi cantly worse at the end of the experiment in animals infused with dias pirin cross-linked hemoglobin, Right lung weights and right thoracic c omputed tomography scan volume were higher with diaspirin cross-linked hemoglobin than with saline, Conclusions: After pulmonary contusion, resuscitation with diaspirin cross-linked hemoglobin led to pulmonary hypertension, greater pulmonary contusion lesion size, and stiffer lun gs in this porcine model.