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Intensive Care Medicine
Published in: Intensive Care Medicine 10/2009

01-10-2009 | Experimental

The impact of inspired oxygen concentration on tissue oxygenation during progressive haemorrhage

Authors: Alex Dyson, Ray Stidwill, Val Taylor, Mervyn Singer

Published in: Intensive Care Medicine | Issue 10/2009

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Abstract

Purpose

Standard resuscitation practice for shock states mandates use of high flow, high concentration oxygen. However, this may induce microvascular constriction and potentially impair regional oxygen delivery. We thus investigated the impact of varying inspired oxygen concentrations in a rat model of progressive haemorrhage.

Methods

Tissue oxygen tension (the balance between local O2 supply and demand) was measured in four different organ beds (liver, renal cortex, muscle, bladder), with concurrent assessment of cardiorespiratory function and organ perfusion in a spontaneously breathing, anaesthetised rat model. 10% aliquots of circulating blood volume were removed at 15 min intervals until death. Different oxygen fractions in the gas mixture (0.15–1.0) were administered following 20% blood removal. A control group consisted of normovolaemic animals breathing varying oxygen fractions.

Results

Survival times following progressive haemorrhage were similar in animals breathing room air (98 ± 10 min), 60% O2 (102 ± 6 min) or 100% O2 (90 ± 4 min), but significantly worse in those breathing 15% O2 (52 ± 8 min, P < 0.01). Significant derangements of blood pressure, aortic blood flow and lactataemia were observed in both hypoxaemic and hyperoxaemic groups compared to normoxaemic animals. Breathing 100% O2 increased arterial PO2 sevenfold and tPO2 approximately threefold over baseline values during normovolaemia and mild haemorrhage (20% blood volume removal). However, with progressive haemorrhage, and despite maintained PaO2 values, tissue PO2 fell in line with the decrease in global oxygen delivery.

Conclusion

Hypoxaemia and hyperoxaemia both compromised haemodynamics and biochemical markers of organ perfusion during severe, progressive haemorrhage. This may carry implications for resuscitation practice.
Literature
1.
Bitterman H, Reissman P, Bitterman N, Melamed Y, Cohen L (1991) Oxygen therapy in hemorrhagic shock. Circ Shock 33:183–191PubMed
2.
Barth E, Bassi G, Maybauer DM, Simon F, Groger M, Oter S, Speit G, Nguyen CD, Hasel C, Moller P, Wachter U, Vogt JA, Matejovic M, Radermacher P, Calzia E (2008) Effects of ventilation with 100% oxygen during early hyperdynamic porcine fecal peritonitis. Crit Care Med 36:495–503PubMedCrossRef
3.
Garner WL, Downs JB, Reilley TE, Frolicher D, Kargi A, Fabri PJ (1989) The effects of hyperoxia during fulminant sepsis. Surgery 105:747–751PubMed
4.
Cheung PY, Obaid L, Emara M, Brierley Y, Johnson ST, Chan GS, Jewell L, Korbutt G, Bigam DL (2008) Cardio-renal recovery of hypoxic newborn pigs after 18%, 21% and 100% reoxygenation. Intensive Care Med 34:1114–1121PubMedCrossRef
5.
Tsai AG, Cabrales P, Winslow RM, Intaglietta M (2003) Microvascular oxygen distribution in awake hamster window chamber model during hyperoxia. Am J Physiol Heart Circ Physiol 285:H1537–H1545PubMed
6.
Rosser DM, Stidwill RP, Jacobson D, Singer M (1995) Oxygen tension in the bladder epithelium rises in both high and low cardiac output endotoxemic sepsis. J Appl Physiol 79:1878–1882PubMed
7.
Rosser DM, Stidwill RP, Jacobson D, Singer M (1996) Cardiorespiratory and tissue oxygen dose response to rat endotoxemia. Am J Physiol 271:H891–H895PubMed
8.
Hou H, Grinberg OY, Taie S, Leichtweis S, Miyake M, Grinberg S, Xie H, Csete M, Swartz HM (2003) Electron paramagnetic resonance assessment of brain tissue oxygen tension in anesthetized rats. Anesth Analg 96:1467–1472PubMedCrossRef
9.
Vollmar B, Conzen PF, Kerner T, Habazettl H, Vierl M, Waldner H, Peter K (1992) Blood flow and tissue oxygen pressures of liver and pancreas in rats: effects of volatile anesthetics and of hemorrhage. Anesth Analg 75:421–430PubMedCrossRef
10.
Whitehouse T, Stotz M, Taylor V, Stidwill R, Singer M (2006) Tissue oxygen, hemodynamics in renal medulla, cortex, corticomedullary junction during hemorrhage-reperfusion. Am J Physiol Renal Physiol 291:F647–F653PubMedCrossRef
11.
Dyson A, Stidwill R, Taylor V, Singer M (2007) Tissue oxygen monitoring in rodent models of shock. Am J Physiol Heart Circ Physiol 293:526–533CrossRef
12.
Knudson MM, Lee S, Erickson V, Morabito D, Derugin N, Manley GT (2003) Tissue oxygen monitoring during hemorrhagic shock and resuscitation: a comparison of lactated Ringer’s solution, hypertonic saline dextran, and HBOC-201. J Trauma 54:242–252PubMedCrossRef
13.
Nordin A, Mildh L, Makisalo H, Harkonen M, Hockerstedt K (1998) Hepatosplanchnic and peripheral tissue oxygenation during treatment of hemorrhagic shock: the effects of pentoxifylline administration. Ann Surg 228:741–747PubMedCrossRef
14.
Kram HB, Appel PL, Fleming AW, Shoemaker WC (1986) Conjunctival and mixed-venous oximeters as early warning devices of cardiopulmonary compromise. Circ Shock 19:211–220PubMed
15.
Shoemaker WC, Fink S, Ray CW, McCartney S (1984) Effect of hemorrhagic shock on conjunctival and transcutaneous oxygen tensions in relation to hemodynamic and oxygen transport changes. Crit Care Med 12:949–952PubMedCrossRef
16.
Tremper KK, Waxman K, Shoemaker WC (1979) Effects of hypoxia and shock on transcutaneous PO2 values in dogs. Crit Care Med 7:526–531PubMedCrossRef
17.
Gottrup F, Gellett S, Kirkegaard L, Hansen ES, Johansen G (1989) Effect of hemorrhage and resuscitation on subcutaneous, conjunctival, and transcutaneous oxygen tension in relation to hemodynamic variables. Crit Care Med 17:904–907PubMedCrossRef
18.
Drucker W, Pearce F, Glass-Heidenreich L, Hopf H, Powell C, Ochsner MG, Frankel H, Murray D, Nelson M, Champion H, Rozycki G, Silva J, Malcolm D, DeNobile J, Harviel D, Rich N, Hunt TK (1996) Subcutaneous tissue oxygen pressure: a reliable index of peripheral perfusion in humans after injury. J Trauma 40:S116–S122PubMedCrossRef
19.
Vallet B, Lund N, Curtis SE, Kelly D, Cain SM (1994) Gut and muscle tissue PO2 in endotoxemic dogs during shock and resuscitation. J Appl Physiol 76:793–800PubMed
20.
Boekstegers P, Weidenhofer S, Pilz G, Werdan K (1991) Peripheral oxygen availability within skeletal muscle in sepsis and septic shock: comparison to limited infection and cardiogenic shock. Infection 19:317–323PubMedCrossRef
21.
Peitzman AB, Billiar TR, Harbrecht BG, Kelly E, Udekwu AO, Simmons RL (1995) Hemorrhagic shock. Curr Probl Surg 32:925–1002PubMedCrossRef
22.
Boura C, Caron A, Longrois D, Mertes PM, Labrude P, Menu P (2003) Volume expansion with modified hemoglobin solution, colloids, or crystalloid after hemorrhagic shock in rabbits: effects in skeletal muscle oxygen pressure and use versus arterial blood velocity and resistance. Shock 19:176–182PubMedCrossRef
23.
Schlichtig R, Kramer DJ, Boston JR, Pinsky MR (1991) Renal O2 consumption during progressive hemorrhage. J Appl Physiol 70:1957–1962PubMedCrossRef
24.
Thurau K, Boylan JW (1976) Acute renal success. The unexpected logic of oliguria in acute renal failure. Am J Med 61:308–315PubMedCrossRef
25.
Rousseau A, Bak Z, Janerot-Sjoberg B, Sjoberg F (2005) Acute hyperoxaemia-induced effects on regional blood flow, oxygen consumption and central circulation in man. Acta Physiol Scand 183:231–240PubMedCrossRef
26.
Milone SD, Newton GE, Parker JD (1999) Hemodynamic and biochemical effects of 100% oxygen breathing in humans. Can J Physiol Pharmacol 77:124–130PubMedCrossRef
27.
Pasgaard T, Stankevicius E, Jorgensen MM, Ostergaard L, Simonsen U, Frobert O (2007) Hyperoxia reduces basal release of nitric oxide and contracts porcine coronary arteries. Acta Physiol (Oxf) 191:285–296CrossRef
28.
Mak S, Egri Z, Tanna G, Colman R, Newton GE (2002) Vitamin C prevents hyperoxia-mediated vasoconstriction and impairment of endothelium-dependent vasodilation. Am J Physiol Heart Circ Physiol 282:H2414–H2421PubMed
29.
Dallinger S, Dorner GT, Wenzel R, Graselli U, Findl O, Eichler HG, Wolzt M, Schmetterer L (2000) Endothelin-1 contributes to hyperoxia-induced vasoconstriction in the human retina. Invest Ophthalmol Vis Sci 41:864–869PubMed
30.
Jackson WF (1989) Arteriolar oxygen reactivity is inhibited by leukotriene antagonists. Am J Physiol 257:H1565–H1572PubMed
31.
Messina EJ, Sun D, Koller A, Wolin MS, Kaley G (1994) Increases in oxygen tension evoke arteriolar constriction by inhibiting endothelial prostaglandin synthesis. Microvasc Res 48:151–160PubMedCrossRef
32.
Forkner IF, Piantadosi CA, Scafetta N, Moon RE (2007) Hyperoxia-induced tissue hypoxia: a danger? Anesthesiology 106:1051–1055PubMedCrossRef
33.
Floyd TF, Clark JM, Gelfand R, Detre JA, Ratcliffe S, Guvakov D, Lambertsen CJ, Eckenhoff RG (2003) Independent cerebral vasoconstrictive effects of hyperoxia and accompanying arterial hypocapnia at 1 ATA. J Appl Physiol 95:2453–2461PubMed
34.
McNulty PH, Robertson BJ, Tulli MA, Hess J, Harach LA, Scott S, Sinoway LI (2007) Effect of hyperoxia and vitamin C on coronary blood flow in patients with ischemic heart disease. J Appl Physiol 102:2040–2045PubMedCrossRef
35.
Yu M, Morita SY, Daniel SR, Chapital A, Waxman K, Severino R (2006) Transcutaneous pressure of oxygen: a noninvasive and early detector of peripheral shock and outcome. Shock 26:450–456PubMedCrossRef
36.
Yu M, Chapital A, Ho HC, Wang J, Takanishi D Jr (2007) A prospective randomized trial comparing oxygen delivery versus transcutaneous pressure of oxygen values as resuscitative goals. Shock 27:615–622PubMedCrossRef
37.
Goeckenjan G, Strasser K (1977) Relation of transcutaneous to arterial PO2 in hypoxaemia, normoxaemia and hyperoxaemia. Investigations in adults with normal circulation and in patients with circulatory insufficiency. Biotelemetry 4:77–87PubMed
38.
O’connor PM, Anderson WP, Kett MM, Evans RG (2006) Renal preglomerular arterial-venous O2 shunting is a structural anti-oxidant defence mechanism of the renal cortex. Clin Exp Pharmacol Physiol 33:637–641PubMedCrossRef
39.
Ba ZF, Wang P, Koo DJ, Cioffi WG, Bland KI, Chaudry IH (2000) Alterations in tissue oxygen consumption and extraction after trauma and hemorrhagic shock. Crit Care Med 28:2837–2842PubMedCrossRef
40.
Meier J, Kemming GI, Kisch-Wedel H, Blum J, Pape A, Habler OP (2004) Hyperoxic ventilation reduces six-hour mortality after partial fluid resuscitation from hemorrhagic shock. Shock 22:240–247PubMedCrossRef
41.
Takasu A, Stezoski SW, Stezoski J, Safar P, Tisherman SA (2000) Mild or moderate hypothermia, but not increased oxygen breathing, increases long-term survival after uncontrolled hemorrhagic shock in rats. Crit Care Med 28:2465–2474PubMedCrossRef
42.
Takasu A, Prueckner S, Tisherman SA, Stezoski SW, Stezoski J, Safar P (2000) Effects of increased oxygen breathing in a volume controlled hemorrhagic shock outcome model in rats. Resuscitation 45:209–220PubMedCrossRef
43.
Douzinas EE, Livaditi O, Andrianakis I, Prigouris P, Paneris P, Villiotou V, Betrosian AP (2008) The effect of hypoxemic resuscitation from hemorrhagic shock on blood pressure restoration and on oxidative and inflammatory responses. Intensive Care Med 34:1133–1141PubMedCrossRef
44.
Metadata
Title
The impact of inspired oxygen concentration on tissue oxygenation during progressive haemorrhage
Authors
Alex Dyson
Ray Stidwill
Val Taylor
Mervyn Singer
Publication date
01-10-2009
Publisher
Springer-Verlag
Published in
Intensive Care Medicine / Issue 10/2009
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI
https://doi.org/10.1007/s00134-009-1577-2

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