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Thomas K. Day DVM MS DACVA DACVECC 《Journal of Veterinary Emergency and Critical Care》2003,13(2):77-93
Objective: To review the human and veterinary literature on the current development and use of hemoglobin‐based oxygen‐carrying solutions. Human data synthesis: Hemoglobin‐based oxygen‐carrying (HBOC) solutions have been developed extensively over the last 3 decades. Early problems associated with pure hemoglobin and cytoskeleton residues have been resolved with chemical modification of the hemoglobin tetramer resulting in effective oxygen‐carrying molecules of either human or bovine origin. The limited availability of human red blood cells and concerns of disease transmission, the difficulty in mass production of genetically produced hemoglobin solutions (recombinant hemoglobin), and the wide availability of bovine blood have resulted in the development of bovine‐derived HBOC solutions. Research efforts have been directed toward determining the effects of HBOC solutions on tissue perfusion as the target uses of HBOC solutions in human medicine are the perioperative period, shock, and trauma fluid resuscitation. The most controversial issues regarding the cardiovascular effects of HBOC solutions surround increased vasoactivity. Some HBOC formulations have been removed from advanced clinical trials due to intense vasoactivity resulting in increased morbidity. There are currently 3 HBOC solutions in the latter stages of phase III clinical trials: Hemolink®, a Hemopure®, b and PolyHeme®. c The hemoglobin source of Hemopure® is bovine, and the hemoglobin source for Hemolink® and Polyheme® is human. Veterinary data synthesis: The only HBOC solution that has gained approval from the FDA is the veterinary product Oxyglobin®. d Oxyglobin® is 13 g/dL of ultrapurified, polymerized hemoglobin solution of bovine origin in a modified lactated Ringer's solution. There is a significant colloid effect and it also provides a plasma source of oxygen‐carrying capacity. The solution is stable at room temperature for 3 years; there is no special preparation required prior to use and no cross‐match is required prior to administration (contains no cell membranes). Veterinary publications on the use of Oxyglobin® include laboratory investigations in dogs, cats, and horses for use as a resuscitation fluid and for the treatment of anemia. Clinical use of Oxyglobin® in dogs, cats, birds, horses, and other mammalian species has been reported in several publications. Conclusion: The search for a safe, effective HBOC solution for use in human medicine is ongoing. Soon, there will be one or several products approved for use in the perioperative period and/or for the treatment of shock and trauma. The practice of veterinary emergency and critical care has been provided a unique opportunity to apply the use of an HBOC solution (Oxyglobin®) to various aspects of perfusion and oxygen‐carrying needs. Continued clinical experience and research is essential in understanding the use of HBOC solutions in veterinary medicine. 相似文献
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Marie E. Kerl DVM DACVIM DACVECC Paige F. Langdon DVM DACVIM Charles E. Wiedmeyer DVM PhD DACVP Keith R. Branson DVM DACVA 《Journal of Veterinary Emergency and Critical Care》2007,17(1):37-44
Objective: To evaluate the degree of interference that administration of hemoglobin glutamer‐200 (Hb‐200) caused for complete blood counts (CBC), biochemical profiles, cooximetry, and point of care (POC) testing in healthy dogs. Design: Prospective, longitudinal experimental study. Setting: Veterinary medical teaching hospital. Animals: Six purpose‐bred research hounds. Interventions: Dogs were administered FDA‐approved hemoglobin‐based oxygen carrier (Hb‐200) intravenously at 7.5 mL/kg over 2 hours. Arterial and venous blood samples were obtained before administration (Time 0) and at 3, 8, 14, 26, 50, 74, 98, 122, and 146 hours following administration. Measurements and main results: No adverse health effects were observed in any of the dogs. Characteristic mucous membrane, serum, and plasma color changes occurred following administration of Hb‐200. Laboratory values that were significantly lower than baseline included packed cell volume, red blood cell count, hemoglobin, hematocrit, creatinine, cholesterol, alanine aminotransferase, and alkaline phosphatase. Laboratory values that were significantly greater than baseline included mean corpuscular hemoglobin concentration, arterial pH, arterial total carbon dioxide, arterial bicarbonate, amylase, albumin, total protein, globulin, calcium, phosphorous, total bilirubin, carboxyhemoglobin, and methemoglobin. All values returned to baseline by the completion of the 146‐hour monitoring period. Conclusions: In normal dogs, administration of Hb‐200 resulted in statistically significant changes in multiple laboratory parameters; however, these changes are not likely to be clinically significant in the care of critically ill dogs. 相似文献
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Anesthetic management of the head trauma patient 总被引：1，自引：0，他引：1
Elizabeth A. Armitage-Chan MA VetMB DACVA MRCVS Lois A. Wetmore DVM ScD DACVA Daniel L. Chan DVM DACVECC DACVN MRCVS 《Journal of Veterinary Emergency and Critical Care》2007,17(1):5-14
Objective: To describe the optimal anesthetic management of patients with brain injury, with emphasis on the support of oxygen delivery to the brain, and the effects of anesthetic agents on cerebral perfusion. Data sources: Clinical and experimental studies from both the human and veterinary neuroanesthesia literature. Summary: The management of patients following primary traumatic brain injury (TBI) significantly impacts outcome. Outcome can be improved by strategies that improve oxygen delivery to the brain and prevent cerebral ischemia. Anesthetic agents have widely variable effects on the blood supply to the brain and, therefore, choice of anesthetic agent can influence neurological outcome. Although in the past, anesthetic agents have been selected for their neuroprotective properties, it is increasingly being recognized that the support of cerebral perfusion during anesthesia contributes more significantly to a positive outcome for these patients. Support of cardiorespiratory function is, therefore, highly important when anesthetizing patients with TBI. Conclusion: Choice of anesthetic agent is determined by the extent of brain injury and intracranial pressure (ICP) elevation. Factors that should be considered when anesthetizing head trauma patients include the effects of anesthetic agents on the cardiac and respiratory systems, their effects on cerebral blood flow (CBF), ICP, and possible neuroprotective benefits offered by certain agents. 相似文献
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Bernd Driessen DVM Dr. med. vet. DACVA ECVPT Benjamin Brainard VMD 《Journal of Veterinary Emergency and Critical Care》2006,16(4):276-299
Objective: To review the rationale behind and experiences with traditional and newly evolving concepts of fluid therapy in the traumatized patient, and to review conventional and novel fluid preparations for use in trauma resuscitation. Data sources: Human and veterinary clinical and research studies. Human data synthesis: Current treatment guidelines recommend aggressive fluid resuscitation with lactated ringers solution (LRS) or saline as optimum management of hemorrhagic shock in trauma, regardless of whether bleeding is controlled or not. The rationale behind this strategy is to restore intravascular volume as rapidly as possible to ensure adequate vital organ perfusion. Recently, this strategy has been challenged, especially in patients with uncontrolled hemorrhage, as neither laboratory evidence nor clinical trials support this practice. Current research indicates that vigorous fluid infusion may exacerbate bleeding and cause severe hemodilution, both impairing resuscitation outcome. As a result, a new line of thinking is emerging that balances the risks and benefits of intravenous volume infusion by offering the clinician alternative treatment strategies and emphasizes continuous endpoint‐oriented monitoring. ‘Hypotensive’ or ‘hypovolemic’ resuscitation techniques as well as initial volume replacement with fluids other than LRS or saline (e.g., hypertonic saline [HTS], HTS with dextran 70 [HTS‐D]) have been introduced in human medical practice as additional options for treatment of victims of trauma under certain circumstances. Clinical studies evaluating the use of hemoglobin‐based oxygen carriers (HBOCs) in the trauma setting are underway and may soon lead to an expansion of the fluid arsenal available to the clinician for treatment of trauma patients. Veterinary data synthesis: Based on available animal data, neither strict guidelines nor a clear fluid preference for resuscitation of traumatic shock have been defined. Although systematic clinical trials are missing, combinations of crystalloid and colloid (natural or artificial) appear to be as effective for resuscitation as crystalloid alone. Judicious use of an HBOC (e.g., Oxyglobin®) as a substitute for blood/red blood cells may be recommended in situations where whole blood or pRBCs are not or not yet available. Conclusions: The search for optimal methods of fluid resuscitation in trauma is ongoing. At this point the best solution is a differentiated approach to fluid therapy, one that tailors type and volume of resuscitation solution(s) used to the type and severity of injury in an individual patient and uses monitoring of perfusion and oxygenation parameters to guide resuscitation. Crystalloid fluids are effective for resuscitation but may need to be combined with or replaced by colloidal fluids in certain clinical situations. 相似文献
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William Muir DVM PhD DACVA DACVECC 《Journal of Veterinary Emergency and Critical Care》2006,16(4):253-263
Objective: To review the physiology, pathophysiology, and consequences of trauma. The therapeutic implications of hypovolemia, hypotension, hypothermia, tissue blood flow, oxygen delivery, and pain will be discussed. Data Sources: Human and veterinary clinical and research studies. Human and veterinary data synthesis: Trauma is defined as tissue injury that occurs more or less suddenly as a result of violence or accident and is responsible for initiating hyothalamic–pituitary–adrenal axis, immunologic and metabolic responses that are designed to restore homeostasis. Tissue injury, hemorrhage, pain, and fear are key components of any traumatic event. Trauma and blood loss result in centrally integrated autonomic‐mediated cardiovascular responses that are designed to increase heart rate, systemic vascular resistance, and maintain arterial blood pressure (ABP) to vital organs at the expense of blood flow to the gut and skeletal muscle. Severe trauma elicits exuberant physiologic, immunologic, and metabolic changes predisposing the animal to organ malfunction, a systemic inflammatory response, infection, and multiple organ dysfunctions. The combination of both central and local influences produces regional redistribution of blood flow among and within tissue beds which, when combined with impaired vascular reactivity, leads to maldistribution of blood flow to tissues predisposing to tissue hypoperfusion and impaired oxygen delivery and extraction. Gut blood flow and viability may serve as a sentinel of patient survival. These consequences are magnified in animals suffering from pain or that become hypothermic. Successful treatment of traumatized animals goes beyond the restoration of blood pressure and urine output, is dependent on a fundamental understanding of the pathophysiologic processes responsible for the animals current physical status, and incorporates the reduction of pain, stress, and the systemic inflammatory response and methods that restore microcirculatory blood flow and tissue oxygenation. Conclusions: Severe trauma is a multifaceted event and is exacerbated by hypothermia, pain, and stress. Therapeutic approaches must go beyond the simple restoration of vascular volume and ABP by maintaining tissue blood flow, restoring tissue oxygenation, and preventing systemic inflammation. 相似文献
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