A quantitative analysis of transcapillary refill in severe hemorrhagic hypotension in dogs.
In pressure-driven hemorrhage (PDH), where the rate of bleeding is a function of prevailing arterial pressure, survival time, arterial pressure, cardiac output, oxygen consumption, and base excess are functions of initial bleeding rate. The quantitative rate of transcapillary refill (TR) throughout PDH leading to death was determined in splenectomized dogs, through serial analysis of Cr51-tagged red cell dilution. Mild, moderate, and severe levels of PDH were produced by varying initial bleeding rate (10, 25, and 50 ml/min, respectively). The rate of TR is a function of the severity of PDH, but does not correlate with arterial pressure, cardiac output, or systemic resistance. The volume of transferred fluid represents an ever increasing fraction of total plasma volume, and accounts for more than 75% of plasma volume in preterminal stages of shock. TR sustains a relatively fixed level of plasma volume, equivalent to two-third of the initial plasma volume, irrespective of the rate of bleeding. Hypertonic NaCl (7.5%) enhances TR, while isotonic NaCl reverses it.
Prist
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R
Research Division, Faculdade de Medicina, Universidade de São Paulo, Brazil.
Rocha-e-Silva
M
M
Scalabrini
A
A
Coelho
I J
IJ
França
E S
ES
Meneghetti
C
C
Braga
G A
GA
D000818:Animals; D016063:Blood Loss, Surgical; D002196:Capillaries / Q000502:physiology*; D004285:Dogs; D004911:Erythrocyte Volume; D006470:Hemorrhage / Q000503:physiopathology*; D007022:Hypotension / Q000503:physiopathology*; D008297:Male; D008433:Mathematics; D012039:Regional Blood Flow; D012151:Resuscitation; D013156:Splenectomy