טכניון מכון טכנולוגי לישראל
הטכניון מכון טכנולוגי לישראל - בית הספר ללימודי מוסמכים  
M.Sc Thesis
M.Sc StudentWeissmann Marina
SubjectTreatment of Controlled Hemorrhagic Shock Combined with
Brain Injury
DepartmentDepartment of Medicine
Supervisors Professor Emeritus Michael Krausz
Dr. Dalit Dar
Full Thesis textFull thesis text - English Version


Abstract

BACKGROUND: One of the most frequent injury patterns in polytraumatized patients leading to early death is hemorrhagic shock (HS) combined with brain injury (BI). The main goals of management in these patients are to stop the source of bleeding, and prevent brain hypoxia by restoring intravascular volume. There is ongoing debate with regard to the choice of optimal type and amount of resuscitation fluid. The goal of the present study was to investigate what is the optimal resuscitation in BI combined with controlled HS (CHS). 

METHODS: Lewis rats were anesthetized, intubated and ventilated. Open traumatic BI was induced and 30% of the circulating blood volume was withdrawn during 50 minutes, followed by 1 hour resuscitation using 3 volumes of whole blood (WB), hypertonic saline (HTS), and fresh frozen plasma (FFP). Blood samples were collected for determination of blood gases, electrolytes, and metabolite levels. 24 and 48 hours after injury, series of tests for determination of alterations in rat’s cognitive and motor abilities were performed. 48 hours after the injury, blood samples were withdrawn for leukocyte count and integrin expression measurements. Lung sections were collected for immunohistochemical staining.

RESULTS: In rats subjected to combined BI and HS a mortality of 40% was observed. Treatment with WB and HTS significantly reduced mortality, while treatment with FFP resulted in milder reduction in mortality. HS resulted in a decrease in mean arterial pressure (MAP) and base excess (BE), and increase in pO2 and lactate levels. Addition of BI before the hemorrhage resulted in significantly slower recovery during 1 hour observation period. Administration of WB, HTS and FFP improved MAP, pO2 pressure and lactate. The improvement in BE was observed only in rats resuscitated with WB and FFP. Behavioral performances were impaired in rats subjected to BI or BI?. Resuscitation with increasing volumes of WB, FFP and low volume HTS resulted in improvement in rats' behavioral performances. Proportion of neutrophils in rats' circulation and in rats' lungs was higher in all rats subjected to BI, CHS or both. Resuscitation with increasing volumes of WB and low volume HTS decreased the amount of circulating neutrophils. Integrin expression was elevated on leukocytes of all rats subjected to BI, CHS, or both. Resuscitation with HTS and FFP resulted in decreased expression of integrins on leukocytes.

CONCLUSION: Resuscitation with high volume WB or low volume HTS were the optimal treatment for BI combined with CHS.