title: The coherence of macrocirculation, microcirculation, and tissue metabolic response during nontraumatic hemorrhagic shock in swine.
abstract: Hemorrhagic shock is clinically observed as changes in macrocirculatory indices, while its main pathological constituent is cellular asphyxia due to microcirculatory alterations. The coherence between macro- and microcirculatory changes in different shock states has been questioned. This also applies to the hemorrhagic shock. Most studies, as well as clinical situations, of hemorrhagic shock include a "second hit" by tissue trauma. It is therefore unclear to what extent the hemorrhage itself contributes to this lack of circulatory coherence. Nine pigs in general anesthesia were exposed to a controlled withdrawal of 50% of their blood volume over 30 min, and then retransfusion over 20 min after 70 min of hypovolemia. We collected macrocirculatory variables, microcirculatory blood flow measurement by the fluorescent microspheres technique, as well as global microcirculatory patency by calculation of Pv-aCO2, and tissue metabolism measurement by the use of microdialysis. The hemorrhage led to anticipated changes in macrocirculatory variables with a coherent change in microcirculatory and metabolic variables. In the late hemorrhagic phase, the animals' variables generally improved, probably through recruitment of venous blood reservoirs. After retransfusion, all variables were normalized and remained same throughout the study period. We find in our nontraumatic model consistent coherence between changes in macrocirculatory indices, microcirculatory blood flow, and tissue metabolic response during hemorrhagic shock and retransfusion. This indicates that severe, but brief, hemorrhage with minimal tissue injury is in itself not sufficient to cause lack of coherence between macro- and microcirculation.
authors.affiliation: Department of Anesthesiology and Intensive Care Medicine, Trondheim University Hospital, Trondheim, Norway halvor.langeland@ntnu.no.|Department of Circulation and Medical Imaging, Faculty of Medicine Norwegian University of Science and Technology (NTNU), Trondheim, Norway.
authors.forename: Halvor
authors.identifier: http://orcid.org/0000-0001-8155-1514
authors.initials: H
authors.lastname: Langeland
authors.affiliation: Unit of Comparative Medicine, Faculty of Medicine Norwegian University of Science and Technology (NTNU), Trondheim, Norway.
authors.forename: Oddveig
authors.initials: O
authors.lastname: Lyng
authors.affiliation: Department of Anesthesiology and Intensive Care Medicine, Trondheim University Hospital, Trondheim, Norway.|Department of Circulation and Medical Imaging, Faculty of Medicine Norwegian University of Science and Technology (NTNU), Trondheim, Norway.
authors.forename: Petter
authors.initials: P
authors.lastname: Aadahl
authors.affiliation: Department of Anesthesiology and Intensive Care Medicine, Trondheim University Hospital, Trondheim, Norway.|Department of Circulation and Medical Imaging, Faculty of Medicine Norwegian University of Science and Technology (NTNU), Trondheim, Norway.
authors.forename: Nils-Kristian
authors.initials: NK
authors.lastname: Skjærvold
mesh_terms: D000818:Animals; D062186:Arterial Pressure / Q000502:physiology*; D006339:Heart Rate / Q000502:physiology*; D006439:Hemodynamics / Q000502:physiology*; D008297:Male; D008833:Microcirculation / Q000502:physiology*; D017551:Microdialysis; D012771:Shock, Hemorrhagic / Q000503:physiopathology*; D013552:Swine
keywords: Hemorrhagic shock; microcirculation; microdialysis; microspheres; pig; swine