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Background: Logistics complicate fluid resuscitation of traumatic shock on the battlefield. Traumatic shock can result in oxygen debt (O(2)D) accumulation that is fatal. However, the ability of fluid strategies to repay O(2)D are not commonly reported. This pilot study examined various resuscitation fluids, including a combination of PEGylated bovine hemoglobin and hypertonic saline (AfterShock™) on their ability to repay O(2)D in traumatic shock., Methods: 41 anesthetized swine underwent hemorrhage to an O(2)D of 80 mL/kg. Animals received one of the following: 500 mL whole blood, 500 mL AfterShock™, 500 mL hypertonic (7.2%) saline, 250 mL hypertonic (7.2%) saline, 500 mL Hetastarch (6%), or 500 mL lactated Ringer's. Oxygen transport variables (O(2)D, oxygen consumption, oxygen delivery, central venous hemoglobin oxygen saturation, oxygen extraction ratios), lactate clearance, and survival were monitored for 3h after treatment. Data were analyzed using mixed-model ANOVA and comparisons were made to the performance of whole blood., Results: Only animals receiving AfterShock™, 500 mL hypertonic saline, and 500 mL Hetastarch survived to 180 min. While not statistically significant AfterShock™ demonstrated trends in improving the repayment of O(2)D and in improving oxygen transport variables despite having lower levels of global oxygen delivery compared to whole blood, Hetastarch and 500 mL hypertonic saline groups., Conclusion: Use of 500 mL AfterShock™, 500 mL of 7.2% saline or 500 mL of Hetastarch resulted in improved short-term survival. While not statistically significant, AfterShock™ demonstrated trends in improving O(2)D. These findings may have implications for designing resuscitation fluids for combat casualty care., (Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.)

Background: Clot strength by Thrombelastography (TEG) is associated with mortality during trauma and has been linked to severity of tissue hypoperfusion. However, the optimal method for monitoring this important relationship remains undefined. We hypothesize that oxygen transport measurements will be associated with clot strength during traumatic shock, and test this hypothesis using a swine model of controlled traumatic shock., Methods: N = 33 swine were subjected to femur fracture and hemorrhagic shock by controlled arterial bleeding to a predetermined level of oxygen debt measured by continuous indirect calorimetry. Hemodynamics, oxygen consumption, systemic central venous oxygenation (ScvO₂), base excess, lactate, and clot maximal amplitude by TEG (TEG-MA) as clot strength were measured at baseline and again when oxygen debt = 80 ml/kg during shock. Oxygen transport and metabolic markers of tissue perfusion were then evaluated for significant associations with TEG-MA. Forward stepwise selection was then used to create regression models identifying the strongest associations between oxygen transport and TEG-MA independent of other known determinants of clot strength., Results: Multiple markers of tissue perfusion, oxygen transport, and TEG-MA were all significantly altered during shock compared to baseline measurements (p < 0.05). However, only ScvO₂ demonstrated a strong bivariate association with TEG-MA measured during shock (R = 0.7, p < 0.001). ScvO₂ measured during shock was also selected by forward stepwise selection as an important covariate in linear regression models of TEG-MA after adjusting for the covariates fibrinogen, pH, platelet count, and hematocrit (Whole model R² = 0.99, p ≤ 0.032)., Conclusions: Among multiple measurements of oxygen transport, only ScvO₂ was found to retain a significant association with TEG-MA during shock after adjusting for multiple covariates. ScvO₂ should be further studied for its utility as a clinical marker of both tissue hypoxia and clot formation during traumatic shock.

Eighty-six children with burn injuries hospitalized in intensive care wards during the acute period of burn disease were examined. They were divided into 3 groups: with involvement of up to 30%, 31-60%, and more than 61% of body surface. The children were examined during and after shock. The study was aimed at investigating the delivery, consumption, and extraction of oxygen in order to assess the criteria of disorders in the blood gas transporting system. In group 1 these parameters were higher than normally during the acute period, reflecting the adequate reaction to burn injury. Therapeutic measures required volume support with infusion media. In the second and third groups these parameters were increased both during and after shock; for increasing oxygen transport, inotropic support was administered. In the third group oxygen delivery was within the norm which did not correspond to its consumption and, hence, respiratory support was needed.

External respiration and blood gas composition were examined in 187 children aged 1 to 14 years during the acute period of burn disease (burn shock and toxemia). The patients were divided into three groups with different area of thermal injury to the skin. Group 1 were children with burns of up to 10% of body surface area. The ventilation parameters in this group were changed just negligibly, and the diffusion capacity of the lungs and gas composition of arterial blood were within the normal range of values both during shock and toxemia. In patients with burns involving 11 to 20% of body surface the ventilation parameters were changed appreciably and did not compensate for each other, as was observed in group 1. The diffusion capacity of the lungs and blood gas composition values were moderately decreased. During toxemia the minute-consumption of oxygen was decreased and alveolar oxygen tension remained unchanged. As a result of this, the diffusion capacity of the lungs and blood gas parameters continued to decrease. The most dynamic changes were observed in children with burns involving 21 to 45% of body surface. The ventilation-diffusion disorders and blood gas composition were altered, particularly so during toxemia; the changes consisted in a decrease of the minute ventilation volume and oxygen tension in arterial blood and a moderate increase of alveolar oxygen tension, which led to further decrease of the diffusion capacity of the lungs. In parallel with the disorders in the above parameters, x-ray changes in the lungs were observed, which were characterized by a vascular-interstitial pattern in group 2 and infiltrative changes in group 3. In children with burn wounds of 35 to 45% of body surface these changes presented as the developing lung edema.

The state of the gas exchange system was analyzed in 79 patients with a severe combined trauma (SCT) at the postshock period. It allowed detection of specific features of disturbances of the oxygen transport by blood in different kinds of injuries. The SCT with a critical injury of the brain is more often accompanied by hyperdynamia of circulation within the first two days after trauma, while the 3rd-4th days are characterized by a sharp drop of the heart index to (2,17 +/- 0,21) l/min.m2, oxygen transport to (261,9 +/- 37,2) ml/min.m2, oxygen consumption to (99,9 +/- 8,3) ml/min.m2. If the SCT was accompanied by a contusion of the heart the changes of central hemodynamics were especially pronounced and prolonged having a hypocirculatory character with a decreased cardiac and stroke index from the first hours of stay at the hospital (20,4 +/- 1,5) ml/m2 and (2,10 +/- 0,14) ml/min.m2 correspondingly. It led to a substantial decrease of indicators of the transport and consumption of oxygen correspondingly: (266,5 +/- 25,1) ml/min.m2 and (112,6 +/- 8,2) ml/min.m2. For the pathogenetically substantiated therapy of disturbances of the oxygen transport by blood the following measures are considered: isovolemic hemodilution, moderate sympathetic blockade, the use of membrane stabilizers, glucocorticoids, adrenolytics, solcoseryl. The state of the organism system of respiration and subsystem of the oxygen transport must be taken into consideration when choosing the optimum time for performing the postponed operative interventions at the postshock period.

A series of 10 seriously injured patients requiring resuscitation and definitive operative control of hemorrhage was studied. Simultaneous arterial and mixed venous blood gases were measured sequentially throughout the resuscitative and operative periods. Improvement of the mixed venous oxygen saturation was associated with survival. In this study, mixed venous oxygen saturations were valuable predictors of survival and were a helpful parameter to monitor during the resuscitative, operative, and immediate postoperative periods.