scholarly journals Intraosseous Fluid Resuscitation Causes Systemic Fat Emboli in a Porcine Hemorrhagic Shock Model

2021 ◽  
Author(s):  
Steinar Kristiansen ◽  
Benjamin Storm ◽  
Dalia Dahle ◽  
Terje Domaas Josefsen ◽  
Knut Dypwik ◽  
...  
Keyword(s):  
Hemorrhagic Shock ◽  
Fluid Resuscitation ◽  
Left Kidney ◽  
Median Sternotomy ◽  
Fat Embolism ◽  
Shock Model ◽  
Open Chest ◽  
Embolism Syndrome ◽  
Systemic Embolization ◽  
Life Saving

Abstract BackgroundIntraosseous cannulation can be life-saving when intravenous access cannot be readily achieved. However, it has been shown that the procedure may cause fat emboli to the lungs and brain. Fat embolization may cause serious respiratory failure and fat embolism syndrome. We investigated whether intraosseous fluid resuscitation in pigs in hemorrhagic shock caused pulmonary or systemic embolization to the heart, brain, or kidneys and if this was enhanced by open chest conditions.MethodsWe induced hemorrhagic shock in anesthetized pigs followed by fluid-resuscitation through bilaterally placed tibial intraosseous cannulas. A subgroup underwent median sternotomy with pericardiectomy and pleurotomy before hemorrhagic shock was induced. We used invasive hemodynamic and respiratory monitoring including Swan Ganz pulmonary artery catheter and transesophageal echocardiography and obtained biopsies from the lungs, heart, brain, and left kidney postmortem.ResultsAll pigs exposed to intraosseous infusion had pulmonary fat emboli in postmortem biopsies. Additionally, seven of twenty-one pigs had coronary fat emboli. None of the pigs with open chest had fat emboli in postmortem lung, heart, or kidney biopsies. During fluid-resuscitation, three pigs developed significant ST-elevations on ECG; all of these animals had coronary fat emboli on postmortem biopsies. ConclusionsSystemic fat embolism occurred in the form of coronary fat emboli in a third of the animals who underwent intraosseous fluid resuscitation. Open chest conditions did not increase the incidence of systemic fat embolization.

scholarly journals Intraosseous fluid resuscitation causes systemic fat emboli in a porcine hemorrhagic shock model

2021 ◽  
Vol 29 (1) ◽  
Author(s):  
Steinar Kristiansen ◽  
Benjamin Storm ◽  
Dalia Dahle ◽  
Terje Domaas Josefsen ◽  
Knut Dybwik ◽  
...  
Keyword(s):  
Hemorrhagic Shock ◽  
Fluid Resuscitation ◽  
Left Kidney ◽  
Median Sternotomy ◽  
Fat Embolism ◽  
Shock Model ◽  
Open Chest ◽  
Embolism Syndrome ◽  
Systemic Embolization ◽  
Life Saving

Abstract Background Intraosseous cannulation can be life-saving when intravenous access cannot be readily achieved. However, it has been shown that the procedure may cause fat emboli to the lungs and brain. Fat embolization may cause serious respiratory failure and fat embolism syndrome. We investigated whether intraosseous fluid resuscitation in pigs in hemorrhagic shock caused pulmonary or systemic embolization to the heart, brain, or kidneys and if this was enhanced by open chest conditions. Methods We induced hemorrhagic shock in anesthetized pigs followed by fluid-resuscitation through bilaterally placed tibial (hind leg) intraosseous cannulas. The fluid-resuscitation was limited to intraosseous or i.v. fluid therapy, and did not involve cardiopulmonary resuscitation or other interventions. A subgroup underwent median sternotomy with pericardiectomy and pleurotomy before hemorrhagic shock was induced. We used invasive hemodynamic and respiratory monitoring including Swan Ganz pulmonary artery catheter and transesophageal echocardiography and obtained biopsies from the lungs, heart, brain, and left kidney postmortem. Results All pigs exposed to intraosseous infusion had pulmonary fat emboli in postmortem biopsies. Additionally, seven of twenty-one pigs had coronary fat emboli. None of the pigs with open chest had fat emboli in postmortem lung, heart, or kidney biopsies. During intraosseous fluid-resuscitation, three pigs developed significant ST-elevations on ECG; all of these animals had coronary fat emboli on postmortem biopsies. Conclusions Systemic fat embolism occurred in the form of coronary fat emboli in a third of the animals who underwent intraosseous fluid resuscitation. Open chest conditions did not increase the incidence of systemic fat embolization.

scholarly journals Effects of Preoxygenation on Desaturation Time during Hemorrhagic Shock in Pigs

2010 ◽  
Vol 113 (3) ◽  
pp. 593-599 ◽  
Author(s):  
Daniel Pehböck ◽  
Volker Wenzel ◽  
Wolfgang Voelckel ◽  
Kim Jonsson ◽  
Holger Herff ◽  
...  
Keyword(s):  
Blood Loss ◽  
Airway Management ◽  
Hemorrhagic Shock ◽  
Fluid Resuscitation ◽  
Fold Increase ◽  
Oxygen Desaturation ◽  
Shock Model ◽  
Peripheral Oxygen Saturation ◽  
Emergent Airway Management ◽  
Hemorrhagic Shock Model

Background Patients in hemorrhagic shock often require emergent airway management. Clinical experience suggests that oxygen desaturation occurs rapidly in these patients; however, data are scant. The hypothesis of this study was that increasing levels of hemorrhagic shock, varying levels of fraction of inspired oxygen (Fio2) for preoxygenation, and fluid resuscitation significantly affect the duration until critical desaturation occurs. Methods Fifteen pigs were studied in a hemorrhagic shock model with controlled hemorrhage (15, 30, and 45 ml/kg blood loss) and randomized to standard fluid resuscitation or no fluids. At each shock level, three apnea experiments (in randomized order) were performed after 5 min of preoxygenation at 21, 50, or 100% Fio2. After preoxygenation, ventilation was discontinued and the time to peripheral oxygen saturation of 70% or less was measured. Results During normovolemia, peripheral oxygen desaturation to less than 70% occurred after 33+/-7 s (Fio2=0.21, mean+/-SD), 89+/-12 s (Fio2=0.5), and 165+/-22 s (Fio2=1.0; P<0.001). During increasing blood loss, peripheral oxygen desaturation to Spo2 less than 70% occurred significantly (P<0.001) faster compared with normovolemia, but no effect of fluid resuscitation was observed. With 45 ml/kg blood loss, peripheral oxygen desaturation to less than 70% occurred after approximately 15 (Fio2=0.21) to 65 (Fio2=0.5) to 140 s (Fio2=1.0). Conclusions Findings from this swine hemorrhagic shock model confirm that Fio2 and the level of hemorrhagic shock, but not fluid resuscitation, influence the rate of apneic desaturation. A five-fold increase in time until critical oxygen desaturation occurs can be achieved when preoxygenating with 100% oxygen compared with room air, underscoring the importance of adequate preoxygenation before emergent airway management.

scholarly journals Fluid resuscitation-related coagulation impairment in a porcine hemorrhagic shock model

PeerJ ◽  
2020 ◽  
Vol 8 ◽  
pp. e8399
Author(s):  
Alexander Ziebart ◽  
Robert Ruemmler ◽  
Christian Möllmann ◽  
Jens Kamuf ◽  
Andreas Garcia-Bardon ◽  
...  
Keyword(s):  
Hemorrhagic Shock ◽  
Fluid Resuscitation ◽  
Organ Damage ◽  
Shock Model ◽  
Coagulation Activity ◽  
Laboratory Parameters ◽  
Arterial Blood ◽  
Life Threatening ◽  
The Impact ◽  
Hemorrhagic Shock Model

Background Fast and effective treatment of hemorrhagic shock is one of the most important preclinical trauma care tasks e.g., in combat casualties in avoiding severe end-organ damage or death. In scenarios without immediate availability of blood products, alternate regimens of fluid resuscitation represent the only possibility of maintaining sufficient circulation and regaining adequate end-organ oxygen supply. However, the fluid choice alone may affect the extent of the bleeding by interfering with coagulation pathways. This study investigates the impact of hydroxyethyl starch (HES), gelatine-polysuccinate (GP) and balanced electrolyte solution (BES) as commonly used agents for fluid resuscitation on coagulation using a porcine hemorrhagic shock model. Methods Following approval by the State and Institutional Animal Care Committee, life-threatening hemorrhagic shock was induced via arterial blood withdrawal in 24 anesthetized pigs. Isovolumetric fluid resuscitation with either HES, GP or BES (n = 3 × 8) was performed to compensate for the blood loss. Over four hours, hemodynamics, laboratory parameters and rotational thromboelastometry-derived coagulation were analyzed. As secondary endpoint the porcine values were compared to human blood. Results All the agents used for fluid resuscitation significantly affected coagulation. We measured a restriction of laboratory parameters, clot development and clot firmness, particularly in HES- and GP-treated animals. Hemoglobin content dropped in all groups but showed a more pronounced decline in colloid-treated pigs. This effect was not maintained over the four-hour monitoring period. Conclusion HES, GP, and BEL sufficiently stabilized the macrocirculation, but significantly affected coagulation. These effects were most pronounced after colloid and particularly HES administration. Despite suitability for rapid hemodynamic stabilization, colloids have to be chosen with caution, because their molecular properties may affect coagulation directly and as a consequence of pronounced hemodilution. Our comparison of porcine and human coagulation showed increased coagulation activity in pig blood.

scholarly journals Effect of N-acetylcysteine on pulmonary cell death in a controlled hemorrhagic shock model in rats

2012 ◽  
Vol 27 (8) ◽  
pp. 561-565 ◽  
Author(s):  
Paulo Fernandes Saad ◽  
Karen Ruggeri Saad ◽  
Luiz Dantas de Oliveira Filho ◽  
Sueli Gomes Ferreira ◽  
Marcia Kiyomi Koike ◽  
...  
Keyword(s):  
Cell Death ◽  
Hemorrhagic Shock ◽  
Fluid Resuscitation ◽  
Caspase 3 ◽  
Control Group ◽  
Albino Rats ◽  
Shock Model ◽  
Tissue Samples ◽  
Ringer’S Lactate ◽  
Hemorrhagic Shock Model

PURPOSE: To evaluate the effect of N-acetylcysteine (NAC) combined with fluid resuscitation on pulmonary cell death in rats induced with controlled hemorrhagic shock (HS). METHODS: Two arteries (MAP calculation and exsanguination) and one vein (treatments) were catheterized in 22 anesthetized rats. Two groups of male albino rats were induced with controlled HS at 35mmHg MAP for 60 min. After this period, the RL group was resuscitated with Ringer's lactate and the RL+NAC group was resuscitated with Ringer's lactate combined with 150mg/Kg NAC. The control group animals were cannulated only. The animals were euthanized after 120 min of fluid resuscitation. Lung tissue samples were collected to evaluate the following: histopathology, TUNEL and imunohistochemical expression of caspase 3. RESULTS: RL showed a greater number of cells stained by TUNEL than RL + NAC, but there was no change in caspase 3 expression in any group. CONCLUSION: N-acetylcysteine associate to fluid resuscitation, after hemorrhagic shock, decreased cell death attenuating lung injury.

Clinical case of successful treatment of compartment syndrome, complicated by fat embolism syndrome

2018 ◽  
Vol 16 (7(part 1)) ◽  
pp. 81-84
Author(s):  
I. O. Pankov ◽  
◽  
M. M. Gabdullin ◽  
S. D. Sirazitdinov ◽  
◽  
...  
Keyword(s):  
Compartment Syndrome ◽  
Successful Treatment ◽  
Clinical Case ◽  
Fat Embolism ◽  
Fat Embolism Syndrome ◽  
Embolism Syndrome

Bone marrow necrosis and fat embolism syndrome: a near fatal complication in previously undiagnosed sickle beta + thalassaemia

2021 ◽  
Vol 14 (1) ◽  
pp. e238317
Author(s):  
Nibash Budhathoki ◽  
Sunita Timilsina ◽  
Bebu Ram ◽  
Douglas Marks
Keyword(s):  
Bone Marrow ◽  
Multiorgan Failure ◽  
Rare Condition ◽  
Altered Mental Status ◽  
Fat Embolism ◽  
Bone Marrow Necrosis ◽  
Embolism Syndrome ◽  
Hb S ◽  
High Index Of Suspicion ◽  
Specific Symptoms

Prevalence of haemoglobin sickle-β+ thalassaemia (Hb S/β+thal) is variable with geography ranging from 0.2% to 10% among sickle cell patients. Clinical presentation of Hb S/β+thal patients depends on HbA level, with milder disease often going undiagnosed. However, rarely these patients can present with a fulminant vaso-occlusive crisis (VOC). Given VOC can present with non-specific symptoms, the diagnosis and treatment is often delayed. Here, we present a patient who initially developed altered mental status, pancytopenia and multiorgan failure due a critical VOC resulting in bone marrow necrosis and fat embolism. Subsequent workup confirmed that our patient had Sickle-β+ thalassaemia, which had gone undiagnosed, despite subclinical evidence of haemolysis on routine lab work for years. Following diagnosis and initiation of RBC exchange, he improved significantly and was discharged home. High index of suspicion and bone marrow biopsy is vital for early diagnosis and management of this rare condition.

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