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Thoracic, peripheral, and cerebral volume, circulatory and pressure responses to PEEP during simulated hemorrhage in a pig model: a case study

Leslie D. Montgomery
Leslie D. Montgomery
, 
Richard W. Montgomery
Richard W. Montgomery
, 
Michael Bodo
Michael Bodo
, 
Richard T. Mahon
Richard T. Mahon
 und 
Frederick J. Pearce
Frederick J. Pearce
   | 27. Dez. 2021
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Online veröffentlicht: 27. Dez. 2021
Seitenbereich: 103 - 116
Eingereicht: 07. Okt. 2021
DOI: https://doi.org/10.2478/joeb-2021-0013
Schlüsselwörter
© 2021 Leslie D. Montgomery, Richard W. Montgomery, Michael Bodo, Richard T. Mahon, and Frederick J. Pearce, published by Sciendo
This work is licensed under the Creative Commons Attribution 4.0 International License.

Figure 1

Mean arterial pressure (SAP) during the recoding and challenges (bleeding and PEEP). Y-axis is in mmHg; X-axis is clock time. EIS recording stated at 13.43.
Mean arterial pressure (SAP) during the recoding and challenges (bleeding and PEEP). Y-axis is in mmHg; X-axis is clock time. EIS recording stated at 13.43.

Figure 2

Mean pulmonary arterial pressure (PA-M) and simulated hemorrhage (VOLOUT) vs elapsed time. PA-M is not affected by the amount of bleeding prior to the first bleeding. However, PEEP produces an increase in PA-M following the first and second bleed periods.
Mean pulmonary arterial pressure (PA-M) and simulated hemorrhage (VOLOUT) vs elapsed time. PA-M is not affected by the amount of bleeding prior to the first bleeding. However, PEEP produces an increase in PA-M following the first and second bleed periods.

Figure 3

Normalized intravascular (nVblood), cellular (nVcellular) and interstitial (nVinterstital) calf compartment volumes vs. elapsed time.
Normalized intravascular (nVblood), cellular (nVcellular) and interstitial (nVinterstital) calf compartment volumes vs. elapsed time.

Figure 4

Fluid transfer in and out of the cells (Fc), interstitial space (Fi), and intravascular compartment (Fb) vs. elapsed time.
Fluid transfer in and out of the cells (Fc), interstitial space (Fi), and intravascular compartment (Fb) vs. elapsed time.

Figure 5

Mean pulmonary arterial pressure (PA-M) and calf percent blood flow (%BF) vs. elapsed time.
Mean pulmonary arterial pressure (PA-M) and calf percent blood flow (%BF) vs. elapsed time.

Figure 6

Mean pulmonary arterial pressure [PA-M], time of arterial blood inflow (TIN), and time of venous outflow (TOUT) vs. elapsed time.
Mean pulmonary arterial pressure [PA-M], time of arterial blood inflow (TIN), and time of venous outflow (TOUT) vs. elapsed time.

Figure 7

Systemic arterial pressure (SAP) and continuous cardiac output (CCO) vs. elapsed time.
Systemic arterial pressure (SAP) and continuous cardiac output (CCO) vs. elapsed time.

Figure 8

Mean pulmonary arterial pressure (PA-M), stroke volume (SV), and heart rate (HR) vs. elapsed time.
Mean pulmonary arterial pressure (PA-M), stroke volume (SV), and heart rate (HR) vs. elapsed time.

Figure 9

Mean pulmonary arterial pressure (PA-M), stroke volume (SV), and mean cardiac output (CCO) vs. elapsed time.
Mean pulmonary arterial pressure (PA-M), stroke volume (SV), and mean cardiac output (CCO) vs. elapsed time.

Figure 10

Mean pulmonary arterial pressure (PA-M), stroke volume (SV), and time of venous outflow (TOUT) vs. elapsed time.
Mean pulmonary arterial pressure (PA-M), stroke volume (SV), and time of venous outflow (TOUT) vs. elapsed time.

Figure 11

Continuous analog parameters (as a strip chart) vs. time. CBF AR is active.
Continuous analog parameters (as a strip chart) vs. time. CBF AR is active.

Figure 12

Continuous analog parameters (plotted as a strip chart) vs. time. CBF AR is passive.
Continuous analog parameters (plotted as a strip chart) vs. time. CBF AR is passive.

Figure 13

Intracranial pressure (ICP), systemic arterial pressure (SAP), REG integral (REG integral), PRx, and REGx plotted as analog strip chart vs. time. The first number of PRx and REGx calculations starts at 300 sec of the original signal. Pig CBF 9, file 13:32, time window 96.52 min.
Intracranial pressure (ICP), systemic arterial pressure (SAP), REG integral (REG integral), PRx, and REGx plotted as analog strip chart vs. time. The first number of PRx and REGx calculations starts at 300 sec of the original signal. Pig CBF 9, file 13:32, time window 96.52 min.

Figure 14

Phases of shock. The shock phases defined as compensatory represent the removal of 50% and 100% of peak shed blood volume (3% of body weight). Shock phases defined as decompensatory represent the return of 20 and 75% of the shed blood volume [58].
Phases of shock. The shock phases defined as compensatory represent the removal of 50% and 100% of peak shed blood volume (3% of body weight). Shock phases defined as decompensatory represent the return of 20 and 75% of the shed blood volume [58].

Summary of CBF AR changes.

Challenge SAP CFa CFm REG1d CBF LDF ICP CVP PAP CO2 pO2
iso-prop
transit + - - - - + - - +/- 0 -
PEEP 10 - + - + + - + - 0 + -
PEEP 15 - + - + +/- + + - 0 + -
PEEP 20 - + - + +/- + + - - + -
hemorrhage 1 - + - + + + -/+ + + - -/+
PEEP 10 0 0 -/+ + 0 0 + - - + -
PEEP 15 - -/+ -/+ + + 0 + - - + -
PEEP 20 - -/+ -/+ + -/+ -/+ + - + + -
CO2 inhalation + 0 0 0 + 0 + 0 - + -
hemorrhage 2 - + +/- + - 0 - + + 0 +/0
PEEP 10 0 0 + - + 0 + - - + -
PEEP 15 + - + - + 0 + + - + -
PEEP 20 -/+ - - - + + + + - + -
hemorrhage 3 - + - + + 0 - - - + 0
PEEP 10 + 0 0 0 0 0 + +/- + + +
lethal
bleeding - +/- - +/- - - - -/+ +/- -/+ +/-
CBF AR active 7 1 9 4 3 6 3 4 5 3

Percent changes of mean ICP and REG integral during 15 and 20 cmH2O PEEPs before first (1) and after first bleedings (2), and after second bleeding (3). Values are in percentage of their own baseline. Measurement was made at the highest values. Note that after 2nd bleeding REG values are negative, indicating that CBF AR is passive.

ICP
 REG
15 cm H2O 20 cm H2O 15 cm H2O 20 cm H2O
1 132 148 15 31
2 133 148 28 40
3 74 48 -19 -41
eISSN:
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Sprache:
Englisch
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