title: The hemodynamic effects of diaspirin cross-linked hemoglobin in dopamine-resistant endotoxic shock in swine.
abstract: As the blood substitute Diaspirin Cross-linked Hemoglobin (DCLHb) has potent vasopressor activity, we assessed its hemodynamic effects in a clinically relevant dopamine-resistant endotoxic shock model in swine. In a randomized and controlled study, E. coli LPS was administered to anesthetized and invasively monitored swine. Group I (n = 3) control pigs were not resuscitated. Groups II (n = 5) and III (n = 6) pigs received dopamine (DA) after MAP decreased 30%, and hetastarch and DCLHb, respectively, after dopamine-resistance occurred. Progressive hemodynamic decline occurred in Group I pigs. DA failed to restore MAP to baseline. However, 0% and 67% of pigs also treated with heta-starch and DCLHb, respectively, achieved temporary restoration of baseline MAP (p = 0.03), prompting a reduction in the dose of DA in 0% of hetastarch vs. 50% of DCLHb treated pigs. Except for increased MPAP and decreased heart in DCLHb treated pigs (p<0.001), hemodynamics and survival were not different (p>0.05). In conclusion, although DCLHb exacerbated pulmonary hypertension and did not improve O2 utilization or survival, because DCLHb restored MAP to baseline and had a dopamine sparing effect, further investigation of DCLHb's hemodynamic effects in adrenergic agent-resistant endotoxemia is warranted.
authors.affiliation: Department of Anesthesiology, University of Vermont, Burlington, USA. freilichd@nmrc.navy.mil
authors.forename: Erin
authors.initials: E
authors.lastname: Freilich
authors.forename: Daniel
authors.initials: D
authors.lastname: Freilich
authors.forename: Miles
authors.initials: M
authors.lastname: Hacker
authors.forename: Lori
authors.initials: L
authors.lastname: Leach
authors.forename: Shilpa
authors.initials: S
authors.lastname: Patel
authors.forename: James
authors.initials: J
authors.lastname: Hebert
mesh_terms: D000818:Animals; D001241:Aspirin / Q000031:analogs & derivatives* / Q000494:pharmacology*; D001794:Blood Pressure / Q000187:drug effects; D001802:Blood Substitutes / Q000494:pharmacology*; D002316:Cardiotonic Agents / Q000494:pharmacology; D004298:Dopamine / Q000494:pharmacology; D004351:Drug Resistance; D006454:Hemoglobins / Q000494:pharmacology*; D008070:Lipopolysaccharides; D009566:Nitrates / Q000032:analysis; D012151:Resuscitation; D012772:Shock, Septic / Q000139:chemically induced / Q000188:drug therapy* / Q000401:mortality; D015996:Survival Rate; D013552:Swine
chemical_list: D001802:Blood Substitutes; D002316:Cardiotonic Agents; D006454:Hemoglobins; D008070:Lipopolysaccharides; D009566:Nitrates; C083478:diaspirin-cross-linked hemoglobin; D001241:Aspirin; D004298:Dopamine