title: IV perflubron emulsion versus autologous transfusion in severe normovolemic anemia: effects on left ventricular perfusion and function.
abstract: Intact cardiac compensatory mechanisms are necessary to maintain adequate tissue oxygenation during acute normovolemic hemodilution (ANH). Left ventricular (LV) perfusion, oxygenation and function were analyzed in an experimental whole-body model of profound ANH (Hct 9%) and effectiveness of a perfluorocarbon-based oxygen carrier in maintaining myocardial oxygenation and function was evaluated. A total of 22 anesthetized dogs were hemodiluted to Hct 20% followed by a simulated, controlled blood-loss phase in which dogs were randomized to either: (1) 1:1 exchange of lost blood with autologous red blood cells (RBC-group), (2) 1:1 exchange with a colloid (control-group) and (3) 1:1 exchange with a colloid after a single dose of 1.8 g/kg BW perflubron i.v. (PFC-group). Myocardial oxygen delivery and consumption as well as endocardial perfusion were determined using radioactive microspheres. LV myocardial contractility (LV MC) was assessed from: (1) the relationship between maximum rate of LV pressure increase (LVdp/dtmax) and LV enddiastolic volume (LVEDV) and (2) analysis of the LV endsystolic pressure volume relationship (ESPVR). LV diastolic properties were reflected by (1) minimum rate of LV pressure increase (LVdp/dtmin), (2) slope and intercept of the enddiastolic pressure-volume relationship (EDPVR) and (3) the time-constant of isovolumic LV pressure decline "tau 1/2". Full sets of LV MC data were obtained from 18 dogs (n = 6 per group). LV MC (LVdp/dtmax-LVEDV relation) increased after perflubron administration. At the lowest Hct level, all parameters reflecting LV MC as well as LVdp/dtmin were significantly higher in the PFC-group than in the control-group. After profound normovolemic hemodilution (Hct 9%) superiority of LV MC and LV diastolic properties was found, when myocardial oxygenation was supported by i.v. perflubron emulsion, a temporary O2 carrier.
authors.affiliation: Institute for Surgical Research, Ludwig-Maximilians University, Munich, Germany. habler@icf.med.uni-muenchen.de
authors.forename: O
authors.initials: O
authors.lastname: Habler
authors.forename: M
authors.initials: M
authors.lastname: Kleen
authors.forename: J
authors.initials: J
authors.lastname: Hutter
authors.forename: A
authors.initials: A
authors.lastname: Podtschaske
authors.forename: M
authors.initials: M
authors.lastname: Tiede
authors.forename: G
authors.initials: G
authors.lastname: Kemming
authors.forename: M
authors.initials: M
authors.lastname: Welte
authors.forename: C
authors.initials: C
authors.lastname: Corso
authors.forename: S
authors.initials: S
authors.lastname: Batra
authors.forename: P
authors.initials: P
authors.lastname: Keipert
authors.forename: S
authors.initials: S
authors.lastname: Faithfull
authors.forename: K
authors.initials: K
authors.lastname: Messmer
mesh_terms: D000740:Anemia / Q000503:physiopathology / Q000628:therapy; D000818:Animals; D001802:Blood Substitutes / Q000009:adverse effects*; D001804:Blood Transfusion, Autologous; D001810:Blood Volume; D004285:Dogs; D004655:Emulsions; D005260:Female; D005466:Fluorocarbons / Q000008:administration & dosage*; D006400:Hematocrit; D006438:Hemodilution / Q000009:adverse effects / Q000379:methods*; D006439:Hemodynamics; D006842:Hydrocarbons, Brominated; D007262:Infusions, Intravenous; D008297:Male; D010101:Oxygen Consumption; D016277:Ventricular Function, Left
chemical_list: D001802:Blood Substitutes; D004655:Emulsions; D005466:Fluorocarbons; D006842:Hydrocarbons, Brominated; C003072:perflubron