Eight Hours of Hypotensive versus Normotensive Resuscitation in a Porcine Model of Controlled Hemorrhagic Shock

Authors

  • David E. Skarda MD,

    1. From the Department of Surgery, University of Minnesota (DES, KEM, MEG, GJB), Minneapolis, MN; and the Department of Surgery, North Memorial Medical Center (GJB), Robbinsdale, MN.
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  • Kristine E. Mulier MBS,

    1. From the Department of Surgery, University of Minnesota (DES, KEM, MEG, GJB), Minneapolis, MN; and the Department of Surgery, North Memorial Medical Center (GJB), Robbinsdale, MN.
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  • Mark E. George MD,

    1. From the Department of Surgery, University of Minnesota (DES, KEM, MEG, GJB), Minneapolis, MN; and the Department of Surgery, North Memorial Medical Center (GJB), Robbinsdale, MN.
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  • Greg J. Beilman MD

    1. From the Department of Surgery, University of Minnesota (DES, KEM, MEG, GJB), Minneapolis, MN; and the Department of Surgery, North Memorial Medical Center (GJB), Robbinsdale, MN.
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  • Presented at the Surgical Forum, American College of Surgeons Annual Meeting, Chicago, IL, October 2006.

  • Awarded first place, Minnesota State Trauma Paper Competition, American College of Surgeons, Minneapolis, MN, October 2006; and second place, Region V Trauma Paper Competition, American College of Surgeons, Indianapolis, IN, November 2006.

  • This work was funded by the Office of Naval Research (Grant N0001-14-02-1-0093 to GJB).

Address for correspondence and reprints: Greg Beilman, MD; e-mail: beilm001@umn.edu.

Abstract

Objectives:  The aim of this study was to compare hypotensive and normotensive resuscitation in a porcine model of hemorrhagic shock.

Methods:  This was a prospective, comparative, randomized survival study of controlled hemorrhagic shock using 28 male Yorkshire-Landrace pigs (15 to 25 kg). In 24 splenectomized pigs, the authors induced hemorrhagic shock to a systolic blood pressure (sBP) of 48 to 58 mm Hg (∼35% bleed). Pigs were randomized to undergo normotensive resuscitation (sBP of 90 mm Hg, n = 7), mild hypotensive resuscitation (sBP of 80 mm Hg, n = 7), severe hypotensive resuscitation (sBP of 65 mm Hg, n = 6), or no resuscitation (n = 4). The authors also included a sham group of animals that were instrumented and splenectomized, but that did not undergo hemorrhagic shock (n = 4). After the initial 8 hours of randomized pressure-targeted resuscitation, all animals were resuscitated to a sBP of 90 mm Hg for 16 hours.

Results:  Animals that underwent severe hypotensive resuscitation were less likely to survive, compared with animals that underwent normotensive resuscitation. Mean arterial pressure (MAP) decreased with hemorrhage and increased appropriately with pressure-targeted resuscitation. Base excess (BE) and tissue oxygen saturation (StO2) decreased in all animals that underwent hemorrhagic shock. This decrease persisted only in animals that were pressure target resuscitated to a sBP of 65 mm Hg.

Conclusions:  In this model of controlled hemorrhagic shock, initial severe hypotensive pressure-targeted resuscitation for 8 hours was associated with an increased mortality rate and led to a persistent base deficit (BD) and to decreased StO2, suggesting persistent metabolic stress and tissue hypoxia. However, mild hypotensive resuscitation did not lead to a persistent BD or to decreased StO2, suggesting less metabolic stress and less tissue hypoxia.

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