An experimental study on hypotensive resuscitation of near-lethal uncontrolled hemorrhage : Effects on tissue dysoxia, mortality and end-organ function at 72 hours

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The purpose of this study was to evaluate tissue dysoxia, survival and incidence of end-organ injury, 3 days following normotensive and hypotensive resuscitation of uncontrolled hemorrhage. Fifteen canines (Beagle, BW 13〜16kg) were assigned to 3 groups : Groups A, B, and C were hemorrhaged to a mean pressure 40 mmHg in the presence of a 4-mm aortic tear : Group A (n=5) was resuscitated to a mean pressure 100 mmHg for 45 min ; Group B (n=5) was moderately under resuscitated to a mean pressure 60 mmHg for 45 min ; Group C (n=5) was moderately under resuscitated to a mean pressure 60 mmHg simultaneously with hyperoxia (PaO2=600 mmHg) for 45 min. After 45 min, the aortotomy was repaired, and animals were resuscitated baseline physiologic parameters. Gastric mucosal Pco_2, and arterial blood pH were significantly improved in Gr.C as compared to Gr.A and B during the 45 min of moderate under-resuscitation. By 72 h, physiologic parameters in surviving animals had returned to baseline levels. Seventy-two-hour mortality was 80%, 0%, and 0% for Group A through C. Measures of kidney, liver, and pulmonary function did not change from baseline. There was no histologic evidence of end-organ injury. In this model, 45 min of under-resuscitation did not result in end-organ injury. There was a trend toword greater survival, and tissue dysoxia was significantly prevented with hyperoxia with moderate under-resuscitation (mean pressure of 60 mmHg).