USE OF RECOMBINANT HEMOGLOBIN SOLUTION IN REVERSING LETHAL HEMORRHAGIC HYPOVOLEMIC OXYGEN DEBT SHOCK

Citation
Jh. Siegel et al., USE OF RECOMBINANT HEMOGLOBIN SOLUTION IN REVERSING LETHAL HEMORRHAGIC HYPOVOLEMIC OXYGEN DEBT SHOCK, The journal of trauma, injury, infection, and critical care, 42(2), 1997, pp. 199-212
Citations number
20
Categorie Soggetti
Emergency Medicine & Critical Care
Volume
42
Issue
2
Year of publication
1997
Pages
199 - 212
Database
ISI
SICI code
Abstract
Objective: To compare recombinant hemoglobin solution (rHb1.1) with co lloid/blood (CB) resuscitation in a hemorrhagic shock (HS) model based on oxygen debt (O2D). Methods: Twenty-two anesthetized canines (weigh t 23.3 +/- 0.2 kg) were bled to an O2D of 99.9 +/- 2.1 mL/kg over 60 m inutes (estimated Lethal dose 31%), blood loss 65.9 +/- 2.3% of estima ted blood volume, -199 g hemoglobin (Hgb). Prospectively randomized re suscitation done in 20 minutes with 120% of shed blood volume, either colloid 60%/blood 60% shed blood volume (CB), 118 g Hgb, or 120% shed blood volume as 5% rHb1.1, 85 g Hgb, and fall in O2D was quantified ov er 80 minutes, Six animals died during HS, one after CB resuscitation (32% actual mortality), Blood lactate (L) and base deficit (BEA) were related to O2D. Results: Both lactate (L) and BEA quantified O2D durin g hemorrhage: L = 0.0671 (O2D) + 1.209; r(2) = 0.90, p < 0.0001; BEA = 0.1313 (O2D) + 1.764; r(2) = 0.90, p < 0.0001, but L was a better ind icator than BEA of fall in O2D during resuscitation (L = 0.069 (O2D) 1.083; r(2) = 0.80), Both groups were followed for 7 days after HS an d had normal renal and hepatic function by day 7, However, at equal re suscitation volume, rHb1.1 resuscitation with 41% of Hgh loss produced a more rapid initial fall in O2D than CB at 60% of Hgb loss (p < 0.00 2), rHb1.1 resuscitation also caused a more complete washout of metabo lic acids than CB. Conclusions: Lactate and BEA accurately quantify O2 D in HS and resuscitation. rHb1.1 replacement is as good as CB with re gard to survival, but leads to a more uniform reperfusion and produces a more complete resolution of ischemic acidosis.