Summary
We have described increases in lung water and pulmonary vascular resistance and reduced myocardial performance in both pigs and dogs after two hours of haemorrhagic shock followed by re-infusion of blood. In this experiment haemorrhagic shock was induced by removing blood to ACD blood packs in five groups of dogs. After two hours of shock, blood was re-infused and NaHCO3 was given to correct the metabolic acidosis of shock. One group of dogs remained as control and received no drugs. Experiments were carried out on three other groups of dogs with one of aspirin, dextran and methylprednisolone given intravenously at the end of the shock period and before blood was re-infused. To allow absorption, chloroquine was given intramuscularly before the period of shock in the fifth group of dogs. In the group with no drugs pulmonary vascular resistance (PVR) increased 95 per cent (significant) from the control period to the end of the experiment. PVR in the control period was not significantly different from PVR at the end of the experiment in any drug group. However, chloroquin was associated with the greatest increase in PVR between these times (77 per cent N.S.). PVR actually fell from control levels to the end of the experiment in both the aspirin (-3.4 per cent N.S.) and dextran (-2.9 per cent N.S.) groups. PVR rose (14 per cent N.S.) from the control period to the end of the experiment in the methylprednisolone group. The aspirin, dextran and methylprednisolone PVR results are all significantly different from the “no drug” group. In both the aspirin and dextran groups platelet aggregation was inhibited. Only the methylprednisolone group had a significant increase in lung water (21 per cent) and the smallest increase in lung water occurred in the aspirin group (9.8 per cent N.S.). We could not relate lung water changes to PVR changes. The lung water changes were compatible with interstitial pulmonary oedema and did not lead to serious gas exchange problems. Myocardial performance appeared improved with dextran and methylprednisolone after shock.
We conclude that while dextran and methylprednisolone confer some benefit in preventing increases in PVR and lung water after haemorrhage shock, aspirin is the best drug of those studied in preventing these changes.
Résumé
Nous avons montré dans des travaux antérieurs chez des chiens et des porcs qu’un choc hémorragique suivi ďune réinfusion du volume saigné provoquait une augmentation de ľeau pulmonaire extravasculaire et de la résistance vasculaire pulmonaire; de plus, le phénomène était associé à une diminution de ľefficacité myocardique.
Dans cette expérience-ci, nous avons à nouveau produit un choc hémorragique en saignant des chiens et en les maintenant à une pression artérielle moyenne de 50 mm Hg durant deux heures, après quoi le sang versé était retourné à ľanimal et ľon corrigeait, à ľaide de bicarbonate, ľacidose métabolique résultant de la période de choc.
Ľexpérience a porté sur cinq groupes ďanimaux: un premier, servant de témoin, n’a reçu aucun médicament à la suite de la réinfusion du sang versé; les groupes deux, trois, quatre et cinq reçurent respectivement de ľacide acétylsalicylique, de la chloroquine, du dextran, de la méthylprednisolone. Le médicament était administré par voie veineuse avant la réinfusion du sang, sauf pour les animaux du groupe trois où la chloroquine était administrée par voie intramusculaire avant la création du choc pour en assurer ľabsorption.
Article PDF
Similar content being viewed by others
References
Bo, G. &Hognestad, J. Thrombocytes and pulmonary vascular resistance. Microcirculatory approaches to current therapeutic problems. Symposia. 6th Europ. Conf. Microcirculation, Aalborg 1970, pp. 32–34 (Karger, Basch 1971).
Noble, W.H. Early changes in lung water after hemorrhagic shock in pigs and dogs. Can. Anaesth. Soc. J.22: 39–49 (1975).
Connell, R.S., Swank, R.L., &Webb, M.C. The development of pulmonary ultrastructural lesions during hemorrhagic shock. J. of Trauma15: 116–129 (1975).
Goodman, J.R., Lim, R.C., Blaisdell, F.W., Hall, A.D., &Thomas, A.N. Pulmonary microembolism in experimental shock. Am. J. of Pathol.52: 391–400 (1968).
Ljungquist, U.E. &Schwartz, S.I. Pulmonary platelet trapping during shock and pulmonary embolus. J. of Surg. Res.18: 559–565 (1975).
Bergentz, S.E.,Lewis, D.H., &Ljungquist, U. Trapping of platelets in the lung after experimental injury. Microcirculatory approaches to current therapeutic problmes. Symposia 6th Europ. Conf. Microcirculation, Aalborg 1970, pp. 35–40 (Karger, Basel, 1971).
Robb, J. The role of microembolism in the production of irreversible shock. Ann. Surg.158: 685–692 (1963).
McKay, D.G., Margaretten, W., &Csavossy, I. An election microscope study of endotoxin shock in rhesus monkeys. Surg. Gynecol. Obstet.125: 825–832 (1967).
Moss, G.S., Das Gupta, T.K., Newson, B., &Nyhus, L.M. Morphological changes in the primate lung after hemorrhagic shock. Surg. Gynecol. Obstet.134: 3–9 (1972).
Pulmonary effects of non-thoracic trauma. Proceedings of a conference conducted by the committee on Trauma, Div. of Med. Sci., Nat. Acad. of Sci., Nat. Res. Council, J. of Trauma. Vol. 8 (1968).
Depalma, R., Coil, J., Davis, J., &Holden, W. Cellular and ultrastructural changes in endotoxemia: a light and electron microscopic study. Surgery,62: 505 (1967).
Shoemaker, W.C. Pattern of pulmonary hemodynamic and functional changes in shock. The lung in the critically ill patient. Baltimore, Williams & Wilkins Co., pp. 33–43 (1976).
Porcelli, R., Foster, W.M., Bergofsky, E.H., Bicker, A., Kaur, R., Demeny, M., &Reich, T. Pulmonary circulatory changes in pathogenesis of shock lung. Amer. J. of Med. Sci.268: 250–261 (1974).
Cook, W.A. Experimental shock lung model. J. Trauma8: 793 (1968).
Famewo, C.E., Noble, W.H., &Garvey, M.B. Use of aspirin in hemorrhagic shock. Can. Anaesth. Soc. J.22: 50–60, 1975.
Peer, R.M. &Schwartz, S.I. Prevention of pulmonary platelet trapping following trauma. Surgical forum224: 5–7 (Abst.) (1973).
Poller, L. Recent advances in thrombosis. Edinburgh, Churchill-Livingston Co. Ch. 7 (1973).
Weiss, J.A. The effects of clinical dextran on platelet aggregation, adhesion and ADP release in man;in vivo andin vitro studies. J. Lab. Clin. Med.69: 37–46 (1967).
Famewo, C.E., Noble, W.H., &Garvey, M.B. Use of chloroquine in shock. Can. Anaes. Soc. J.22: 687–695 (1975).
Noble, W.H. &Kay, J.C. Cardiac catheterization in dogs. Can. Anaes. Soc. J.21: 616–620 (1974).
Noble, W.H. &Severinghaus, J.W. Thermal and conductivity dilution curves for rapid quantitation of pulmonary edema. J. Appl. Physiol.32: 770–775 (1972).
Noble, W.H., Obdrzalek, J., &Kay, J.C. A new technique for measuring pulmonary edema. J. Appl. Physiol.34: 508–512 (1973).
Nunn, J.F. Applied respiratory physiology, 1st ch. 9: pp. 244, London: Butterworths (1969).
Kuwabara, S. &Duncalf, D. Effect of anatomical shunt on physiologic deadspace-totidal volume ratio: a new equation. Anaesthesiology 31: 575–577 (1969).
McKenzie, N., Heimbegker, R.D., Barnigoat, R.A., &Gergely, N.F. Bloodless openheart surgery with atraumatic extra-corporeal circulation. C.M.A.J.112: 1073–1077 (1975).
Snedecor, G.W. &Cochran, W.G.: Statistical methods. Iowa State Univ. Press, U.S.A. (1967).
Geelhoed, G.W. &Bennett, S.H. Effect of filtration and aged-cell separation in “shock lung” resulting from stored blood perfusion. Surgical forum24: 7–9 (1973).
Bennett, S.H., Geelhold, G.W., Aaron, R.K., Solis, R.T., &Hoye, R.C. Pulmonary injury resulting from perfusion with stored bank blood in the baboon and dog. J. Surg. Res.23: 295–306 (1972).
Davidson, I., Barrett, J.A., Miller, E., &Litwin, M.S. Pulmonary microembolism associated with massive transfusion. Am. Surg.181: 51–57 (1975).
Gelin, L.E. Discussion. Am. Surg.182: 226 (1975).
Radegran, X., Bergentz, S.E., Lewis, D.H., Ljungvist, U., &Olsson, P. Pulmonary effects of induced platelet aggregation. Intravascular obstruction or vasoconstriction? Scand. J. Clin. Lab. Invest.28: 423–427 (1971).
Bo, G. &Hognestad, J. Effects on the pulmonary circulation of suddenly induced intravascular aggregation of blood platelets. Acta. Physiol. Scand.85: 523–531 (1972).
Wilner, G.D., Nassel, H.L., &LeRuy, E.C. Aggregation of platelets by collagen. J. Clinical Investig.47: 2616 (1968).
Klaize, J. Prostaglandins and platelet aggregation. M:Schettler G. (ed.). Platelets and the vessel wall; fibrin deposition. Symposium of the European Atherosclerosis Group. June 15–17, 1969. Georg Thieme Virlag Stuttgart, pp. 54 (1970).
Kloen, J. Relationship between chemical structure and platelet aggregation activity of prostaglandins. Biochem. Biophys. Acta. pp. 187–285 (1969).
RÅdecran, K. Circulatory and respiratory effects of induced platelet aggregation. An experimental study in dogs. Acta Chirurgica Scandinavica Suppl. 420 (1971). Vol. 419-429, pp. 3–24 (1972).
Wilson, J.W.,Ratliff, N.B.,Young, W.G.,Hackel, D.B., &Mikat, E. Changes in the morphology of leukocytes trapped in the pulmonary circulation during hemorrhagic shock.In: Microcirculatory approaches to current therapeutic problems. Symposiums, 6th Europ. Conf. for Microcirculation. Ahlborg, pp. 41–48 (1970). Basel, Switzerland: S. Karger (1971).
Saldeen, T. Trends in microvascular research: the microembolism syndrome. Microvasc. Res.21: 227–259 (1976).
Busch, C., Lindquist, O., &Saldeen, T. Respiratory insufficiency in the dog induced by pulmonary microembolism and inhibition of fibriolysis. Acta Chir. Scand.140: 255–266 (1974).
RÅdecran, K. The effect of acetylsalicylic acid on the peripheral and pulmonary vascular responses to thrombin. Acta Anaesth. Scand.16: 140–146 (1972).
Wilson, J.W. Treatment or prevention of pulmonary cellular damage with pharmacologic doses of corticosteroid.134: 675–681 (1972).
Kusajima, K., Wax, S.D., &Webb, W.R. Effects of methylprednisolone on pulmonary microcirculation. Surg. Gynecol. Obstet.139: 1 (1974).
Grylewski, R.J., Panczenko, B., Kohbut, R., Grodzinska, L., &Ocetkiewicz, A. Corticosteroids inhibit prostaglandin release from perfused mesenteric blood vessels of rabbit and from perfused lungs of sensitized guinea pig. Prostaglandins 10: 343–347 (1975).
Noble, W.H., Kovacs, K., &Kay, J.C. Fine structural changes in haemodynamic pulmonary oedema. Can. Anaesth. Soc. J.21: 275–284 (1974).
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Noble, W.H., Famewo, C.E. & Bernadette Garvey, M. Pulmonary vascular effects of acetylsalicylic acid, chloroquine, dextran and methylprednisolone given after haemorrhagic shock in dogs. Canad. Anaesth. Soc. J. 24, 661–677 (1977). https://doi.org/10.1007/BF03006710
Issue Date:
DOI: https://doi.org/10.1007/BF03006710