title: Microcirculatory alterations during haemorrhagic shock and after resuscitation in a paediatric animal model.
abstract: BACKGROUND
  Haemorrhagic shock is frequent in paediatric trauma patients and after cardiac surgery, especially after cardiopulmonary bypass. It has demonstrated to be related to bad outcome.
  
  
  OBJECTIVE
  To evaluate changes on microcirculatory parameters during haemorrhagic shock and resuscitation in a paediatric animal model. To determine correlation between microcirculatory parameters and other variables routinely used in the monitoring of haemorrhagic shock.
  
  
  METHODS
  Experimental study on 17 Maryland pigs. Thirty minutes after haemorrhagic shock induction by controlled bleed animals were randomly assigned to three treatment groups receiving 0.9% normal saline, 5% albumin with 3% hypertonic saline, or 5% albumin with 3% hypertonic saline plus a bolus of terlipressin. Changes on microcirculation (perfused vessel density (PVD), microvascular blood flow (MFI) and heterogeneity index (HI)) were evaluated and compared with changes on macrocirculation and tisular perfusion parameters.
  
  
  RESULTS
  Shock altered microcirculation: PVD decreased from 13.5 to 12.3 mm mm(-2) (p=0.05), MFI decreased from 2.7 to 1.9 (p<0.001) and HI increased from 0.2 to 0.5 (p<0.001). After treatment, microcirculatory parameters returned to baseline (PVD 13.6 mm mm(-2) (p<0.05), MFI 2.6 (p<0.001) and HI 0.3 (p<0.05)). Microcirculatory parameters showed moderate correlation with other parameters of tissue perfusion. There were no differences between treatments.
  
  
  CONCLUSIONS
  Haemorrhagic shock causes important microcirculatory alterations, which are reversed after treatment. Microcirculation should be assessed during haemorrhagic shock providing additional information to guide resuscitation.
authors.affiliation: Pediatric Intensive Care Department, Gregorio Marañón University General Hospital, Madrid, Spain; Gregorio Marañon Health Research Institute, Madrid, Spain; Mather-Child Health and Development Network (RedSAMID), Spain.
authors.forename: Rafael
authors.initials: R
authors.lastname: González
authors.affiliation: Pediatric Intensive Care Department, Gregorio Marañón University General Hospital, Madrid, Spain; Gregorio Marañon Health Research Institute, Madrid, Spain; Mather-Child Health and Development Network (RedSAMID), Spain.
authors.forename: Javier
authors.initials: J
authors.lastname: Urbano
authors.affiliation: Pediatric Intensive Care Department, Gregorio Marañón University General Hospital, Madrid, Spain; Gregorio Marañon Health Research Institute, Madrid, Spain; Mather-Child Health and Development Network (RedSAMID), Spain.
authors.forename: Jorge
authors.initials: J
authors.lastname: López
authors.affiliation: Pediatric Intensive Care Department, Gregorio Marañón University General Hospital, Madrid, Spain; Gregorio Marañon Health Research Institute, Madrid, Spain; Mather-Child Health and Development Network (RedSAMID), Spain.
authors.forename: Maria J
authors.initials: MJ
authors.lastname: Solana
authors.affiliation: Pediatric Intensive Care Department, Gregorio Marañón University General Hospital, Madrid, Spain.
authors.forename: Marta
authors.initials: M
authors.lastname: Botrán
authors.affiliation: Pediatric Intensive Care Department, Gregorio Marañón University General Hospital, Madrid, Spain.
authors.forename: Ana
authors.initials: A
authors.lastname: García
authors.affiliation: Pediatric Intensive Care Department, Gregorio Marañón University General Hospital, Madrid, Spain; Gregorio Marañon Health Research Institute, Madrid, Spain; Mather-Child Health and Development Network (RedSAMID), Spain.
authors.forename: Sarah N
authors.initials: SN
authors.lastname: Fernández
authors.affiliation: Pediatric Intensive Care Department, Gregorio Marañón University General Hospital, Madrid, Spain; Gregorio Marañon Health Research Institute, Madrid, Spain; Mather-Child Health and Development Network (RedSAMID), Spain. Electronic address: pielvi@hotmail.com.
authors.forename: Jesús
authors.initials: J
authors.lastname: López-Herce
mesh_terms: D000818:Animals; D004195:Disease Models, Animal; D005440:Fluid Therapy; D006439:Hemodynamics; D008833:Microcirculation; D012151:Resuscitation; D012462:Saline Solution, Hypertonic / Q000494:pharmacology*; D012771:Shock, Hemorrhagic / Q000473:pathology*; D013552:Swine
chemical_list: D012462:Saline Solution, Hypertonic
keywords: Children; Colloids; Crystalloid solutions; Haemorrhage; Microcirculation; Shock