Oxygen Delivery and Consumption during Hypothermia and Rewarming in the Dog
Department of Anesthesiology, University of Washington School of Medicine, Seattle 98195. Anesthesiology
(Impact Factor: 5.88).
04/1990; 72(3):510-6. DOI: 10.1097/00000542-199003000-00020
Changes in oxygen consumption (VO2) and oxygen delivery (DO2) were compared in three groups of paralyzed, sedated dogs: 1) a group (n = 5) cooled to 29 degrees C and immediately rewarmed to 37 degrees C; 2) a group (n = 5) cooled to and maintained at 29 degrees C for 24 h, and then rewarmed; and 3) a group (n = 5) maintained at 37 degrees C for 24 h. During the cooling phase, in both the acute and prolonged hypothermia animals, VO2 and DO2 decreased significantly from control values (P less than 0.05). The decrease in DO2 occurred as a result of a similar decrease in cardiac index (CI; P less than 0.05) that was associated with a significant increase in systemic vascular resistance index (SVRI; P less than 0.05). Arteriovenous oxygen content difference (C(a-v)O2), O2 extraction ratio, mixed venous oxygen tension (PVO2), pH, and base deficit (BD) were not different from control values even during prolonged hypothermia. Normothermic control dogs also demonstrated a significant decrease in CI (P less than 0.05) at 24 h. Surface rewarming increased VO2 back to control values in the acute hypothermia group and to values above control (P less than 0.05) in the prolonged hypothermia group. DO2 remained below control in both groups, resulting in a significant increase in O2 extraction (P less than 0.05) and a decrease in PVO2 (P less than 0.05) in the prolonged hypothermia animals. Following rewarming administration of sodium nitroprusside returned DO2, CI, and SVRI to control values but did not increase VO2. All animals survived the study without need for inotropic support.(ABSTRACT TRUNCATED AT 250 WORDS)
Available from: Marianne Thoresen
- "By contrast, Morray and Pavlin (1990) using the same model in dogs described only a slight arterial acidification, which was not statistically significant. There were, however, differences between experimental protocols in the two investigations: Steen et al. (1980) used 30%, whereas Morray and Pavlin (1990) used 100%, oxygen in the inspired gas. Consequently, PaO 2 was 145 to 167 mm Hg in animals of the former study, and 400 to 500 mm Hg in the latter. "
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ABSTRACT: This review analyzes, in some depth, results of studies on the effect of lowered temperatures on cerebral energy metabolism in animals under normal conditions and in some selected pathologic situations. In sedated and paralyzed mammals, acute uncomplicated 0.5- to 3-h hypothermia decreases the global cerebral metabolic rate for glucose (CMR(glc)) and oxygen (CMRo(2)) but maintains a slightly better energy level, which indicates that ATP breakdown is reduced more than its synthesis. Intracellular alkalinization stimulates glycolysis and independently enhances energy generation. Lowering of temperature during hypoxia-ischemia slows the rate of glucose, phosphocreatine, and ATP breakdown and lactate and inorganic phosphate formation, and improves recovery of energetic parameters during reperfusion. Mild hypothermia of 12 to 24-h duration after normothermic hypoxic-ischemic insults seems to prevent or ameliorate secondary failures in energy parameters. The authors conclude that lowered head temperatures help to protect and maintain normal CNS function by preserving brain ATP supply and level. Hypothermia may thus prove a promising avenue in the treatment of stroke and trauma and, in particular, of perinatal brain injury.
Journal of Cerebral Blood Flow & Metabolism 06/2003; 23(5):513-30. DOI:10.1097/01.WCB.0000066287.21705.21 · 5.41 Impact Factor
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ABSTRACT: Hypothermia in critically ill patients can be difficult to treat with standard rewarming (SR) techniques. We developed a rewarming method that is significantly faster than SR. Percutaneously placed femoral arterial and venous catheters were connected to the inflow and outflow side of a countercurrent fluid warmer to create a fistula through the heating mechanism (CAVR). Over a 10-month period 34 hypothermic (temperature less than 35 degrees C) patients were treated. Eighteen received SR only; CAVR was added to SR in the remaining 16 patients. Both groups were similar in APACHE II, Injury Severity, and Acute Physiology scores, prewarming blood and fluid requirements, and incidence of coagulopathy. Hypothermia resolved in 39 minutes with CAVR vs. 3.23 hours with SR (p less than 0.001). This was associated with an improved survival after moderately severe injury (p = 0.04), and a significant reduction in blood and fluid requirements, organ failures, and length of ICU stay.
The Journal of trauma 04/1992; 32(3):316-25; discussion 325-7. DOI:10.1097/00005373-199203000-00009 · 2.96 Impact Factor
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ABSTRACT: Anesthetized, paralyzed and mechanically ventilated pigs were hypoventilated to extreme hypercapnia (PaCO2 approximately 20 kPa) at FiO2 0.5, and allotted to a hypothermic group (31.5 +/- 0.1 degrees C, n = 6) or a control group (39.6 +/- 0.2 degrees C, n = 6). Compared with the controls, the hypothermic animals had higher PaO2 (19.2 vs 15.6 kPa, P < 0.05), SaO2 (97.2 vs 89.3%), SvO2 (78.7 vs 68.2%), end-tidal O2 (34.5 vs 24.8 kPa) and arterial pH (7.01 vs 6.91), (P < 0.01), but lower PvO2 (7.0 vs 10.2 kPa) and PaCO2 (13.2 vs 23.5 kPa), (P < 0.01). Hypothermia reduced O2 delivery (DO2), O2 consumption (VO2) and CO2 production by 40-45% (P < 0.05), but O2 extraction ratio, i.e. VO2.DO(2)-1 x 100(%), did not differ between groups. Hypothermic animals had lower heart rate (127 vs 223 beats.min-1, P < 0.05) and cardiac output (2.5 vs 3.9 l.min-1, P < 0.01). Subsequently, the inspired oxygen fraction (FiO2) was decreased stepwise (0.3, 0.25, 0.21, 0.15, 0.10) at 30-min intervals. At FiO2 0.3, the hypothermic group had higher PaO2 (10.0 vs 5.7 kPa), SaO2 (91.3 vs 28.5%), PvO2 (5.8 vs 3.4 kPa), SvO2 (70.7 vs 10.3%), end-tidal O2 (16.7 vs 8.5 kPa), O2 delivery (344 vs 155 ml.min-1), arterial pH (7.02 vs 6.94) and systemic vascular resistance (3850 vs 1652 dyn.s.cm-5 (38,500 vs 16,520 microN.s.cm-5)) compared with the controls (P < 0.01), while PaCO2 was lower (12.4 vs 22.7 kPa), as well as O2 extraction ratio (23 vs 63%) and O2 half saturation tension (4.3 vs 8.0 kPa) (P < 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)
Acta Anaesthesiologica Scandinavica 05/1993; 37(3):296-302. DOI:10.1111/j.1399-6576.1993.tb03718.x · 2.32 Impact Factor
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