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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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