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J Appl Physiol 91: 1701-1707, 2001;
8750-7587/01 $5.00
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Vol. 91, Issue 4, 1701-1707, October 2001

Normovolemic hemodilution improves oxygen extraction capabilities in endotoxic shock

Jacques Creteur, Qinghua Sun, Omar Abid, Daniel De Backer, Philippe Van Der Linden, and Jean-Louis Vincent

Department of Intensive Care, Erasme University Hospital, Free University of Brussels, B-1070 Brussels, Belgium

We studied the effects of normovolemic hemodilution on tissue oxygen extraction capabilities in a canine model of endotoxic shock. Eighteen anesthetized and mechanically ventilated dogs underwent normovolemic hemodilution with 6% hydroxyethyl starch solution to reach hematocrit (Hct) levels around 40, 30, or 20% before the administration of 2 mg/kg of Escherichia coli endotoxin. Cardiac tamponade was then induced by repeated injections of normal saline into the pericardial sac to reduce cardiac output and study whole body oxygen extraction capabilities. Whole body critical oxygen delivery was lower in the Hct 20% and 30% groups (8.4 ± 0.4 and 10.4 ± 0.7 ml · kg-1 · min-1, respectively) than in the Hct 40% group (12.8 ± 0.8 ml · kg-1 · min-1) (both P < 0.005). The whole body critical oxygen extraction ratio was higher in the Hct 30% and 20% groups (49.1 ± 8.2 and 55.2 ± 4.6%, respectively) than in the Hct 40% group (37.1 ± 4.4 %) (both P < 0.05). Liver critical oxygen extraction ratio was also higher in the Hct 30% and 20% groups than in the Hct 40% group. The arterial lactate concentrations and the gradient between ileum mucosal PCO2 and arterial PCO2 were lower in the Hct 20% and 30% groups than in the Hct 40% group. We conclude that, during an acute reduction in blood flow during endotoxic shock in dogs, normovolemic hemodilution is associated with improved tissue perfusion and increased oxygen extraction capabilities.

sepsis; hypoxia; oxygen availability; dog experiment; tonometry





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