Resuscitation from hemorrhagic shock after traumatic brain injury with polymerized hemoglobin

Abstract Traumatic brain injury (TBI) is often accompanied by hemorrhage, and treatment of hemorrhagic shock (HS) after TBI is particularly challenging because the two therapeutic treatment strategies for TBI and HS often conflict. Ischemia/reperfusion injury from HS resuscitation can be exaggerated...

Descripción completa

Guardado en:

Detalles Bibliográficos
Autores principales:	Cynthia R. Muller, Vasiliki Courelli, Alfredo Lucas, Alexander T. Williams, Joyce B. Li, Fernando Dos Santos, Clayton T. Cuddington, Savannah R. Moses, Andre F. Palmer, Erik B. Kistler, Pedro Cabrales
Formato:	article
Lenguaje:	EN
Publicado:	Nature Portfolio 2021
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/498e933377124b19800d64b418baa677
Etiquetas:	Agregar Etiqueta Sin Etiquetas, Sea el primero en etiquetar este registro!

id	oai:doaj.org-article:498e933377124b19800d64b418baa677
record_format	dspace
spelling	oai:doaj.org-article:498e933377124b19800d64b418baa6772021-12-02T13:24:07ZResuscitation from hemorrhagic shock after traumatic brain injury with polymerized hemoglobin10.1038/s41598-021-81717-32045-2322https://doaj.org/article/498e933377124b19800d64b418baa6772021-01-01T00:00:00Zhttps://doi.org/10.1038/s41598-021-81717-3https://doaj.org/toc/2045-2322Abstract Traumatic brain injury (TBI) is often accompanied by hemorrhage, and treatment of hemorrhagic shock (HS) after TBI is particularly challenging because the two therapeutic treatment strategies for TBI and HS often conflict. Ischemia/reperfusion injury from HS resuscitation can be exaggerated by TBI-induced loss of autoregulation. In HS resuscitation, the goal is to restore lost blood volume, while in the treatment of TBI the priority is focused on maintenance of adequate cerebral perfusion pressure and avoidance of secondary bleeding. In this study, we investigate the responses to resuscitation from severe HS after TBI in rats, using fresh blood, polymerized human hemoglobin (PolyhHb), and lactated Ringer’s (LR). Rats were subjected to TBI by pneumatic controlled cortical impact. Shortly after TBI, HS was induced by blood withdrawal to reduce mean arterial pressure (MAP) to 35–40 mmHg for 90 min before resuscitation. Resuscitation fluids were delivered to restore MAP to ~ 65 mmHg and animals were monitored for 120 min. Increased systolic blood pressure variability (SBPV) confirmed TBI-induced loss of autoregulation. MAP after resuscitation was significantly higher in the blood and PolyhHb groups compared to the LR group. Furthermore, blood and PolyhHb restored diastolic pressure, while this remained depressed for the LR group, indicating a loss of vascular tone. Lactate increased in all groups during HS, and only returned to baseline level in the blood reperfused group. The PolyhHb group possessed lower SBPV compared to LR and blood groups. Finally, sympathetic nervous system (SNS) modulation was higher for the LR group and lower for the PolyhHb group compared to the blood group after reperfusion. In conclusion, our results suggest that PolyhHb could be an alternative to blood for resuscitation from HS after TBI when blood is not available, assuming additional testing demonstrate similar favorable results. PolyhHb restored hemodynamics and oxygen delivery, without the logistical constraints of refrigerated blood.Cynthia R. MullerVasiliki CourelliAlfredo LucasAlexander T. WilliamsJoyce B. LiFernando Dos SantosClayton T. CuddingtonSavannah R. MosesAndre F. PalmerErik B. KistlerPedro CabralesNature PortfolioarticleMedicineRScienceQENScientific Reports, Vol 11, Iss 1, Pp 1-11 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Cynthia R. Muller Vasiliki Courelli Alfredo Lucas Alexander T. Williams Joyce B. Li Fernando Dos Santos Clayton T. Cuddington Savannah R. Moses Andre F. Palmer Erik B. Kistler Pedro Cabrales Resuscitation from hemorrhagic shock after traumatic brain injury with polymerized hemoglobin
description	Abstract Traumatic brain injury (TBI) is often accompanied by hemorrhage, and treatment of hemorrhagic shock (HS) after TBI is particularly challenging because the two therapeutic treatment strategies for TBI and HS often conflict. Ischemia/reperfusion injury from HS resuscitation can be exaggerated by TBI-induced loss of autoregulation. In HS resuscitation, the goal is to restore lost blood volume, while in the treatment of TBI the priority is focused on maintenance of adequate cerebral perfusion pressure and avoidance of secondary bleeding. In this study, we investigate the responses to resuscitation from severe HS after TBI in rats, using fresh blood, polymerized human hemoglobin (PolyhHb), and lactated Ringer’s (LR). Rats were subjected to TBI by pneumatic controlled cortical impact. Shortly after TBI, HS was induced by blood withdrawal to reduce mean arterial pressure (MAP) to 35–40 mmHg for 90 min before resuscitation. Resuscitation fluids were delivered to restore MAP to ~ 65 mmHg and animals were monitored for 120 min. Increased systolic blood pressure variability (SBPV) confirmed TBI-induced loss of autoregulation. MAP after resuscitation was significantly higher in the blood and PolyhHb groups compared to the LR group. Furthermore, blood and PolyhHb restored diastolic pressure, while this remained depressed for the LR group, indicating a loss of vascular tone. Lactate increased in all groups during HS, and only returned to baseline level in the blood reperfused group. The PolyhHb group possessed lower SBPV compared to LR and blood groups. Finally, sympathetic nervous system (SNS) modulation was higher for the LR group and lower for the PolyhHb group compared to the blood group after reperfusion. In conclusion, our results suggest that PolyhHb could be an alternative to blood for resuscitation from HS after TBI when blood is not available, assuming additional testing demonstrate similar favorable results. PolyhHb restored hemodynamics and oxygen delivery, without the logistical constraints of refrigerated blood.
format	article
author	Cynthia R. Muller Vasiliki Courelli Alfredo Lucas Alexander T. Williams Joyce B. Li Fernando Dos Santos Clayton T. Cuddington Savannah R. Moses Andre F. Palmer Erik B. Kistler Pedro Cabrales
author_facet	Cynthia R. Muller Vasiliki Courelli Alfredo Lucas Alexander T. Williams Joyce B. Li Fernando Dos Santos Clayton T. Cuddington Savannah R. Moses Andre F. Palmer Erik B. Kistler Pedro Cabrales
author_sort	Cynthia R. Muller
title	Resuscitation from hemorrhagic shock after traumatic brain injury with polymerized hemoglobin
title_short	Resuscitation from hemorrhagic shock after traumatic brain injury with polymerized hemoglobin
title_full	Resuscitation from hemorrhagic shock after traumatic brain injury with polymerized hemoglobin
title_fullStr	Resuscitation from hemorrhagic shock after traumatic brain injury with polymerized hemoglobin
title_full_unstemmed	Resuscitation from hemorrhagic shock after traumatic brain injury with polymerized hemoglobin
title_sort	resuscitation from hemorrhagic shock after traumatic brain injury with polymerized hemoglobin
publisher	Nature Portfolio
publishDate	2021
url	https://doaj.org/article/498e933377124b19800d64b418baa677
work_keys_str_mv	AT cynthiarmuller resuscitationfromhemorrhagicshockaftertraumaticbraininjurywithpolymerizedhemoglobin AT vasilikicourelli resuscitationfromhemorrhagicshockaftertraumaticbraininjurywithpolymerizedhemoglobin AT alfredolucas resuscitationfromhemorrhagicshockaftertraumaticbraininjurywithpolymerizedhemoglobin AT alexandertwilliams resuscitationfromhemorrhagicshockaftertraumaticbraininjurywithpolymerizedhemoglobin AT joycebli resuscitationfromhemorrhagicshockaftertraumaticbraininjurywithpolymerizedhemoglobin AT fernandodossantos resuscitationfromhemorrhagicshockaftertraumaticbraininjurywithpolymerizedhemoglobin AT claytontcuddington resuscitationfromhemorrhagicshockaftertraumaticbraininjurywithpolymerizedhemoglobin AT savannahrmoses resuscitationfromhemorrhagicshockaftertraumaticbraininjurywithpolymerizedhemoglobin AT andrefpalmer resuscitationfromhemorrhagicshockaftertraumaticbraininjurywithpolymerizedhemoglobin AT erikbkistler resuscitationfromhemorrhagicshockaftertraumaticbraininjurywithpolymerizedhemoglobin AT pedrocabrales resuscitationfromhemorrhagicshockaftertraumaticbraininjurywithpolymerizedhemoglobin
_version_	1718393146609500160

Resuscitation from hemorrhagic shock after traumatic brain injury with polymerized hemoglobin

Ejemplares similares