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  • Poster presentation
  • Open Access

The influence of hypotensive resuscitation in hemorrhagic shock with coexisting severe head injury: an experimental protocol

  • 1,
  • 1,
  • 1,
  • 1,
  • 1,
  • 1 and
  • 1
Critical Care200711 (Suppl 2) :P356

https://doi.org/10.1186/cc5516

  • Published:

Keywords

  • Traumatic Brain Injury
  • Cerebral Blood Flow
  • Dura
  • Internal Jugular Vein
  • Hemorrhagic Shock

Introduction

We examined the efficacy of hypotensive resuscitation, compared with fluid resuscitation, in patients with closed abdominal trauma and coexisting severe head injury.

Method

Female pigs, 25–30 kg body weight, were used. Retrograde catheterization of the internal jugular vein (SjO2) and laparotomy was performed. A surgical knot 4 mm long was made at the aorta, with a 3.0 diameter stitch. The abdomen was closed. Then a craniotomy and traumatic brain injury (TBI) was made. A regional cerebral blood flow catheter (RoCBF) was placed under the dura. After the TBI the intraabdominal hemorrhage was made by pulling the titch (rupture of the aorta). The animals were assigned into two groups: group A (fluid resuscitation) and group B (hypotensive resuscitation). The animals that survived after 1 hour of hemorrhage were managed by surgical checking and with 1 hour more of fluid resuscitation.

Results

See Table 1: RoCBF and SjO2 before and after the surgical checking of the hemorrhage.

Table 1

  

Baseline

5 minutes before

15 minutes before

45 minutes before

5 minutes after

15 minutes after

45 minutes after

Mortality

Group A

RoCBF (ml/min.100 ml)

31.92

35.47

19.32

5.25***

   

100%

 

SjO2 (%)

71.2

32.8

25.7

28.7***

    

Group B

RoCBF (ml/min.100 ml)

30.3

14.2*

14.5*

16.4

33.47

38.24

37.67

50%

 

SjO2 (%)

81.1

25.8***

22.7***

24.4***

38.5**

49.5**

57.1*

 

*P < 0.05, **P < 0.01 and ***P < 0.001 for comparison with baseline.

Conclusion

In group B there was complete restoration of cerebral blood flow and brain oxygenation, after the surgical checking of hemorrhage. Hypotensive resuscitation causes significant reduction in mortality in patients with closed intraabdominal trauma and coexisting head injury, without putting cerebral function in jeopardy.

Authors’ Affiliations

(1)
University of Patras Medical School, Patras, Greece

Copyright

© BioMed Central Ltd. 2007

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