Abstract
BackgroundDuring hemorrhage and resuscitation, clinical and laboratory monitoring is useful to guide further management. However, acute changes in the biochemistry due to blood loss and subsequent crystalloid fluid resuscitation have not been fully studied.Materials and methodsTwelve anesthetized, juvenile pigs were used. Atraumatic exsanguination, corresponding to a total blood loss of 40%, was performed through a catheter and completed 2 h after initiation of the experiment. Arterial samples were analyzed by point-of-care testing and venous samples were analyzed. Oxygen delivery was calculated.ResultsShortly after 40% hemorrhage and concomitant fluid supplementation, there were significant reductions in arterial hemoglobin and hematocrit (approximately 25%, respectively). Oxygen delivery was less than half of the baseline value. Lactate in arterial blood was more than doubled after 40% exsanguination. On average, no other clinically significant changes in any of the analytes were observed, but interindividual dispersion was pronounced.ConclusionsAcute exsanguination was associated with decreased hemoglobin and hematocrit levels and increased lactate levels but limited effects on the other biomarkers that were studied. Increased levels of biomarkers in severely bleeding patients could indicate tissue damage and the source should be further investigated.
Highlights
It is important to be able to distinguish between the effects of the hemorrhage and fluid resuscitation per se, and organ damage, either as a consequence of trauma or as a result of hypoperfusion
Further resuscitation should be guided by a goal-directed strategy [1], including a transfusion protocol, since extensive hemorrhage will result in loss of coagulation factors [2]
Mean arterial pressure (MAP) and CI were significantly reduced after both 20 and 40% exsanguination (P < 0.01; all four calculations)
Summary
It is important to be able to distinguish between the effects of the hemorrhage and fluid resuscitation per se, and organ damage, either as a consequence of trauma or as a result of hypoperfusion. In cases of severe hemorrhage, when blood products are not readily available, resuscitation with crystalloid fluids is currently the first-line treatment. Acute changes in the biochemistry due to blood loss and subsequent crystalloid fluid resuscitation have not been fully studied. Results: Shortly after 40% hemorrhage and concomitant fluid supplementation, there were significant reductions in arterial hemoglobin and hematocrit (approximately 25%, respectively). Conclusions: Acute exsanguination was associated with decreased hemoglobin and hematocrit levels and increased lactate levels but limited effects on the other biomarkers that were studied. Increased levels of biomarkers in severely bleeding patients could indicate tissue damage and the source should be further investigated
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