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Haemorrhagic shock: pathophysiology and treatment

  • G. P. Novelli
  • A. Di Filippo
Part of the Topics in Anaesthesia and Critical Care book series (TIACC)

Abstract

Shock is a condition of generalized deficit of tissue perfusion. It is defined as haemorrhagic shock (HS) when the deficit is due to a reduction in blood volume caused by acute haemorrhage. The early response to haemorrhage involves both neural and humoral components. The stimuli that can elicit this neuroendocrine response include hypovolaemia, pain, respiratory disturbances, infections, emotional arousal, changes in temperature and changes in blood glucose; the final response might be modified by ethanol, pre-existing diseases, drug withdrawal, age etc.

Keywords

Xanthine Oxidase Haemorrhagic Shock Xanthine Oxidase Inhibition Selective Decontamination Inhibit Calcium Influx 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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References

  1. 1.
    Waxman K (1996) Shock: ischemia, reperfusion and inflammation. New Horizons 4:153–160.PubMedGoogle Scholar
  2. 2.
    Trump BF, Berezesky IK (1995) Calcium-mediated cell injury and cell death. FASEB J 9:219–228.PubMedGoogle Scholar
  3. 3.
    Rose S, Pizanis A, Silomon M (1997) Altered hepato-cellular Ca2+ regulation during haemorrhagic shock and resuscitation. Hepatology 25:379–384.PubMedCrossRefGoogle Scholar
  4. 4.
    Rose S, Sayed MM (1997) Superoxide radicals scavenging prevents cellular calcium dys-regulation during intrabdominal sepsis. Shock 7:263–268.PubMedCrossRefGoogle Scholar
  5. 5.
    Silomon M, Rose S (1998) Effect of sodium bicarbonate infusion on hepatocyte Ca2+ overload during resuscitation from haemorrhagic shock. Resuscitation 37:27–32.PubMedCrossRefGoogle Scholar
  6. 6.
    O’Neil P, Ayala A, Wang P, Ba ZF, Morrison MH, Schultze AE et al (1994) Role of Kupffer cells in IL-6 release following trauma-hemorrage and resuscitation. Shock 1:43–47.CrossRefGoogle Scholar
  7. 7.
    West MA, Wilson C (1996) Hypoxic alterations in cellular signal transduction in shock and sepsis. New Horizons 2:168–175.Google Scholar
  8. 8.
    West MA, Li MH, Seatter SC et al (1994) Pre-exposure to hipoxia and septic stimuli differentially regulates endotoxin release of TNF, IL-6, IL-1, PGE2, NO, and Superoxide by macrophages. J Trauma 37:82–90.PubMedCrossRefGoogle Scholar
  9. 9.
    Karukurum M, Shreeniwas R, Chen J et al (1994) Hypoxic induction of IL-8 gene expression in human endothelial cells. J Clin Invest 93:1564–1570.CrossRefGoogle Scholar
  10. 10.
    Gores G, Nieminen A, Wray B (1989) Intracellular pH during chemical hypoxia in coultured rats hepatocytes. J Clin Invest 83:386–396.PubMedCrossRefGoogle Scholar
  11. 11.
    Makisalo HJ, Soini HO, Tapani Lalla ML et al (1988) Subcutaneous and liver tissue oxygen tension in haemorrhagic shock: and experimental study with whole blood and two colloids. Crit Care Med 16:857–861.PubMedCrossRefGoogle Scholar
  12. 12.
    Nordin AJ, Makisalo H, Hockerstedt KAV (1996) Failure of dobutamine to improve liver oxygenation during resuscitation with crystalloid solution after experimental haemorrhagic shock. Eur J Surg 162:973–979.PubMedGoogle Scholar
  13. 13.
    Heughan C, Niinikoski J, Hunt TK (1972) Effect of excessive infusion of saline solution on tissue oxygen transport. Surg Gynecol Obstet 135:257–260.PubMedGoogle Scholar
  14. 14.
    Waxman K, Clar K L, Soliman MH, Parizin S (1991) Pentoxifylline in resuscitation of experimental hemmorrhagic shock. Crit Care Med 19:728–731.PubMedCrossRefGoogle Scholar
  15. 15.
    Lilly CM, Sandhu S, Ishizaka A et al (1989) Pentoxifylline prevents TNF-induced lung injury. Am Rev Resp Dis 139:1361–1368.PubMedGoogle Scholar
  16. 16.
    Powell CC, Schultz SC, Burris DG et al (1995) Subcutaneous oxygen tension: a useful adjunct in assessment of perfusion status. Crit Care Med 23:867–873.PubMedCrossRefGoogle Scholar
  17. 17.
    Novelli GP (1997) Role of free radicals in septic shock. J Physiol Pharmacol 48:517–527.PubMedGoogle Scholar
  18. 18.
    Clarck RA (1990) The Human neutrophil respiratory burst oxidase. J Infect Dis 161:1140–1147.CrossRefGoogle Scholar
  19. 19.
    Reuter A, Klinger W (1992) The influence of systemic hypoxia and reoxigenation on the glutathione redox system of brain, liver, lung and plasma of newborn rats. Exp Toxicol Pathol 44:339–343.PubMedCrossRefGoogle Scholar
  20. 20.
    Schulze-Osthoff K, Beyeart R, Vandevoorde V (1993) Depletion of the mitochondrial electron transporte abrogates the cytotoxic and gene-inductive effects of TNF. EMBO J 12:3095–3104.PubMedGoogle Scholar
  21. 21.
    Suzuki YJ, Mizuno M, Packer L (1994) Signal transduction for NFK B activation: proposed location for antioxidant inhibitable step. J Immunol 153:5008–5015.PubMedGoogle Scholar
  22. 22.
    Abraham E (1996) Alterations in transcriptional regulation of proinflammatory and immunoregulatory cytokine expression by haemorrhage, injury and critical illness. New Horizons 2:184–191.Google Scholar
  23. 23.
    Staal FJ, Anderson MT, Staal GEJ et al (1994) Redox regulation of signal transduction: tyrosine phosphorylation and calcium influx. Proc Natl Acad Sci USA 91:619–623.CrossRefGoogle Scholar
  24. 24.
    Pinault GC, Sanson AJ, Malangoni MA (1997) Inhibition of xanthine oxidase does not influence immunosuppression after haemorrhagic shock. J Trauma 43:911–915.PubMedCrossRefGoogle Scholar
  25. 25.
    Mannion D, Fitzpatrick GJ, Feeley M (1994) Role of xanthine oxidase inhibition in survival from haemorrhagic shock. Circ Shock 42:39–43.PubMedGoogle Scholar
  26. 26.
    Schoemberg MH, Muhl E, Sellin D (1984) Posthypotensive generation of Superoxide free radicals possible role in the pathogenesis of intestinal mucosa damage. Acta Chir Scand 150:301–309.Google Scholar
  27. 27.
    Ar’Rajab A, Dawidson I, Fabia R (1996) Reperfusion injury. New Horizons 4:224–234.Google Scholar
  28. 28.
    Deitch EA, Bridges W, Baker J et al (1988) Haemorrhagic shock induced bacterial translocation is reduced by xanthine oxidase inhibition or inactivation. Surgery 104:191–198.PubMedGoogle Scholar
  29. 29.
    Novelli GP, Livi P, Falsini S et al (1989) Prevenzione del danno da riperfusione mesenterica nel coniglio mediante antiossidanti. Acta Anesth Italica 40:345–355.Google Scholar
  30. 30.
    Ferraro FJ, Rush BF, Simonian GT et al (1995) A comparison of survival at different degrees of haemorrhagic shock in germ free and germ bearing rats. Shock 4:117–120.PubMedCrossRefGoogle Scholar
  31. 31.
    Moore FA, Moore EA, Poggetti R (1991) Gut bacterial traslocation via the portal vein: a clinical perspective with major torso trauma. J Trauma 31:629–638.PubMedCrossRefGoogle Scholar
  32. 32.
    Van Saene HKF, Stoutenbeek CC, Stoller JK (1992) Selective decontamination of digestive tract in ICU: current status and future prospects. Crit Care Med 20:691–703.PubMedCrossRefGoogle Scholar
  33. 33.
    Deitch EA, Rutan R, Waymack JP (1996) Trauma, shock and gut traslocation. New Horizons 4:289–299.PubMedGoogle Scholar
  34. 34.
    Deitch EA, Xu D, Franko L et al (1994) Evidence favouring the role of the gut as a cytokine-generating organ in rats subjected to Haemorrhagic shock. Shock 1:141–146.PubMedCrossRefGoogle Scholar
  35. 35.
    Maier RV, Bulger EM (1996) Endothelial changes after shock and injury. New Horizons 4:211–223.PubMedGoogle Scholar
  36. 36.
    Ratych R, Chuknyiska R, Bulkley G (1987) The primary localization of free radicals generation after after anoxia/reoxygenation in isolated endothelial cells. Surgery 102:122–131.PubMedGoogle Scholar
  37. 37.
    Abello P, Fidler S, Bulkley G (1994) Antioxidant modulate induction of programmed endothelial cell death by endotoxin. Arch Surg 129:134–141.PubMedCrossRefGoogle Scholar
  38. 38.
    Scannell G (1996) Leukocyte responses to hypoxic/ischemic conditions. New Horizons 4:179–183.PubMedGoogle Scholar
  39. 39.
    Abelda S, Smith C, Ward P (1994) Adhesion molecules and inflammatory injury. FASEB J 8:504–512.Google Scholar
  40. 40.
    Mileski W, Winn R, Vedder N (1990) Inhibition of CD18 dependent PMN adherence reduces organ injury after haemorrhagic shock in primates. Surgery 108:206–212.PubMedGoogle Scholar
  41. 41.
    Gamble J, Skinner M, Berndt M (1990) Prevention of activated neutrophil adhesion to endothelium by soluble adhesion protein GMP 140. Science 249:414–417.PubMedCrossRefGoogle Scholar
  42. 42.
    Partrick DA, Moore FA, Moore EE, Barnett CC et al (1996) Neutrophil priming and activation in the pathogenesis of post-injury MOF. New Horizons 4:194–210.PubMedGoogle Scholar
  43. 43.
    Heuer HO, Casals-Stenzel J, Muacevic G et al (1990) Pharmacologic activity of bepafant [WEB 2170], a new selective hetrazapinoic antagonist of PAF. J Pharmacol Exp Ther 255:962–968.PubMedGoogle Scholar
  44. 44.
    Omert L, Tsukada K, Hierholzer C et al (1998) A role of neutrophils in the down regulation of IL-6 and CD14 following haemorrhagic shock. Shock 6:391–396.CrossRefGoogle Scholar
  45. 45.
    Szabò C, Thiemermann C (1993) Invited opinion: role of NO in haemorrhagic, traumatic and anaphylactic shock and thermal injury. Shock 2:145–155.CrossRefGoogle Scholar
  46. 46.
    Gabury J, Woodman RC, Granger DN (1993) NO prevents Leukocyte adherence: role of Superoxide. Am J Physiol 265:H862–H867.Google Scholar
  47. 47.
    Symington PA, Ma XL, Lefer AM (1992) Protective actions of S-nitrtoso-Nacetylpeni-cillamine — SNAP — in a rat model of haemorrhagic shock. Methods Find Exp Clin Pharmacol 14:789–797.PubMedGoogle Scholar
  48. 48.
    Thiemermann C, Szabò C, Mitchell JA, Vane JR (1993) Vascular hyporeactivity to vasoconstrictor agents and haemodynamic decompensation in haemorrhagic shock mediated by NO. Proc Natl Acad Sci USA 90:267–271.PubMedCrossRefGoogle Scholar
  49. 49.
    Kilbourne RG, Gross SS, Jubran A, Adams J et al (1990) N-methyl-L-Arginine inhibits TNF induced hypotension: implications for the involvment of NO. Proc Natl Acad Sci USA 87:3629–3632.CrossRefGoogle Scholar
  50. 50.
    Szabò C, Mitchell JA, Gross SS et al (1993) PAF contributes to the induction of NO synthetase by bacterial lipopolysaccharide. Circ Res 73:991–999.PubMedCrossRefGoogle Scholar
  51. 51.
    Csaki C, Szabò C, Kovac AGB (1992) Role of PAF in the development of endothelial dysfunction in haemorrhagic hypotension and retrasfusion. Thrombosis Res 66:23–31.CrossRefGoogle Scholar
  52. 52.
    Brady AJB, Poole-Wilson PA, Harding SE et al (1992) NO production within cardiac myocytes reduces their contractility in endotoxemia. Am J Physiol 263:H1963–H1966.PubMedGoogle Scholar
  53. 53.
    Weizberg E, Rudehill A, Lundberg JM (1993) NO inhalation attenuates hypertension and improves gas exchanges in endotoxin shock. Eur J Pharmacol 233:85–94.CrossRefGoogle Scholar
  54. 54.
    Wright CE, Rees DD, Moncada S (1992) Protective and pathological roles of NO in endotoxin shock. Cardiovasc Res 26:48–57.PubMedCrossRefGoogle Scholar
  55. 55.
    Harbrecht BG, Wu B, Watkins SC et al (1995) Inhibition of NOS during haemorrhagic shock increases hepatic injury. Shock 4:332–337.PubMedCrossRefGoogle Scholar
  56. 56.
    Kilbourne RG, Szabò C, Traber DL (1997) Benefical versus detrimental effects of NO synthase inhibitors in circulatory shock: lesson learned from experimental and clinical studies. Shock 7:235–246.CrossRefGoogle Scholar
  57. 57.
    Szabò C (1996) DNA Strand breakage and activation of PARS a cytotoxic pathway triggered by peroxynitrite. Free Rad Biol and Med 21:855–869.CrossRefGoogle Scholar
  58. 58.
    Zingarelli B, Ischiropulos HI, Salzman AL et al (1997) Amelioration by mercaptoethyl-guanidine of the vascular and energetic failure in haemorrhagic shock in anesthetised rat. Eur J Pharmacol 338:55–65.PubMedCrossRefGoogle Scholar
  59. 59.
    Pastores McCarthy S, Hasko G, Vizi S et al (1996) Cytokine production and its manipulation by vasoactive drugs. New Horizons 4:252–264.Google Scholar
  60. 60.
    Spengler RN, Allen RM, Remick DG (1990) Stimulation of adrenergic receptor augments of macrophage derived TNF. J Immunol 145:1430–1445.PubMedGoogle Scholar
  61. 61.
    Liao J, Keiser JA, Scales WE et al (1995) Role of epinephrine in TNF and IL-6 production from isolated perfused rat liver. Am J Physiol 268:R896–R901PubMedGoogle Scholar

Copyright information

© Springer-Verlag Italia 1999

Authors and Affiliations

  • G. P. Novelli
  • A. Di Filippo

There are no affiliations available

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