Fuente de Financiamiento / Número de Biología Molecular del shock hemorrágico GM053789

<ol>
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L., Uchida, T., Kramer, G. C. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Fluid+compartment+in+hemorrhaged+rats+after+hyperosmotic+crystalloid+and+hyperoncotic+crystalloid+resuscitation.">Fluid compartment in hemorrhaged rats after hyperosmotic crystalloid and hyperoncotic crystalloid resuscitation.</a> Am J Physiol. 270, F1-F8 (1996).</li><li>Perel, P., Roberts, I. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Colloids+vs+crystalloids+for+fluid+resuscitation+in+critically+ill+patients.">Colloids vs crystalloids for fluid resuscitation in critically ill patients.</a> Cochrane Database System Rev. 4, CD000567-CD000567 (2007).</li></ol>

Los experimentos con animales fueron supervisados ​​y realizados de acuerdo con las directrices y normas establecidas por el Cuidado de Animales institucional y el empleo y la conducta de Investigación y Cumplimiento de la Universidad de Pittsburgh, un AALAS plenamente acreditado / institución AALAC. Las fuentes animales incluyen Jackson Laboratories y Laboratorios Charles Rivers. Todos los animales se someten garantía de salud amplia a través de cada proveedor, así como la Universidad de Pittsburgh programas internos de vigilancia de la salud de los animales. Esta investigación se lleva a cabo de acuerdo con los directores de gobierno de los EE.UU. para el uso de animales vertebrados. El programa está registrado con el USDA, y tiene una carta de garantía con la Oficina de Servicios de Salud Pública de Protección de los Animales de Laboratorio.

<table border="1"><tbody><tr><th> Instrumento </th><th> Fabricante </th><th> Número de catálogo </th></tr><tr><td> Dumonts (SS/45 ángulo 0.2x0.12mm punta, longitud 13,5 cm) </td><td> Herramientas de Bellas Ciencia </td><td> 11203-25 </td></tr><tr><td> Tijeras quirúrgicas (recta de 12 cm) </td><td> Herramientas de Bellas Ciencia </td><td> 14068-12 </td></tr><tr><td> Hemostatos (curvo 12,5 cm) </td><td> Herramientas de Bellas Ciencia </td><td> 13009-12 </td></tr><tr><td> Microtijeras (primavera de tijera recta de 8 cm) </td><td> Herramientas de Bellas Ciencia </td><td> 15000-00 </td></tr><tr><td> Fórceps (0,8 mm de punta, curvas a 10 cm) </td><td> Herramientas de Bellas Ciencia </td><td> 11050-10 </td></tr><tr><td> sutura carrete 6-0 </td><td> Herramientas de Bellas Ciencia </td><td> 18020-60 </td></tr><tr><td> sutura 4-0 PDSII </td><td> Penn Vet </td><td> ETHZ304H </td></tr><tr><td> gasa 4x4 </td><td> se pueden comprar a través de cualquier proveedor mundial </td><td></td></tr><tr><td> algodón punta del aplicador </td><td> se pueden comprar a través de cualquier proveedor mundial </td><td></td></tr><tr><td> 30G aguja </td><td> se pueden comprar a través de cualquier proveedor mundial </td><td></td></tr><tr><td> 23G aguja </td><td> se pueden comprar a través de cualquier proveedor mundial </td><td></td></tr><tr><td> 3cc jeringa </td><td> se pueden comprar a través de cualquier proveedor mundial </td><td></td></tr><tr><td> 5cc jeringa </td><td> se pueden comprar a través de cualquier proveedor mundial </td><td></td></tr><tr><td> 10cc jeringa </td><td> se pueden comprar a través de cualquier proveedor mundial </td><td></td></tr><tr><td> Tubo cónico de 50 cc </td><td> se pueden comprar a través de cualquier proveedor mundial </td><td></td></tr><tr><td> 1cc jeringa w / 25G aguja </td><td> Fisher Scientific </td><td> 14-826-88 </td></tr><tr><td> De polietileno de 10 tubos de 100 `(PE-10) </td><td> Fisher Scientific </td><td> 14 a 170-12P </td></tr><tr><td> De polietileno de 50 tubos de 100 `(PE-50) </td><td> Fisher Scientific </td><td> 14 a 170-12B </td></tr><tr><td> Llave de 3 vías </td><td> Fisher Scientific </td><td> NC9779127 </td></tr><tr><td> almohadilla azul quirúrgica </td><td> Fisher Scientific </td><td> 50-7105 </td></tr><tr><td> Apósitos estériles de campo </td><td> Fisher Scientific </td><td> NC9517505 </td></tr><tr><td> rollos de cinta de 1 &quot; </td><td> Corporate Express </td><td> MMM26001 </td></tr><tr><td> recta frascos de boca ancha lado (se usa como tope para cono de la nariz) </td><td> VWR </td><td> 159000-058 </td></tr><tr><td> bandeja de acero inoxidable de 8 &quot;x 11&quot; </td><td> VWR </td><td> 62687-049 </td></tr><tr><td> macho-macho de bloqueo leur de 3 vías </td><td> VWR </td><td> 20068-909 </td></tr><tr><td> esterilización bolsa de 3 &quot;x 8&quot; </td><td> VWR </td><td> 24008 </td></tr><tr><td> esterilización bolsa de 5 &quot;x 10&quot; </td><td> VWR </td><td> 24010 </td></tr><tr><td> Microscopio salvaje M650 w / pluma de pie </td><td> Leica </td><td></td></tr><tr><td> Leica IC D cámara digital / imagen en vivo </td><td> Leica </td><td></td></tr><tr><td> Digi-Med BPA-400 analizador y un integrador de sistemas </td><td> Micro-Med </td><td> SYS-400 </td></tr><tr><td> TXD-310 (Digi-Med transductor) </td><td> Micro-Med </td><td> TXD-300 </td></tr><tr><td> Computadora </td><td> Dell </td><td></td></tr><tr><td> Caliente cordón esterilizador de instrumentos </td><td> VWR </td><td> 18000-45 </td></tr><tr><td> Oster A5 Clippers w. tamaño de la hoja 40 </td><td> VWR </td><td> 10749-020 </td></tr><tr><td> circulación heating cojín 18x26 </td><td> Harvard </td><td> py872-5272 </td></tr><tr><td> termómetro rectal </td><td> Kent Científico </td><td> RET-3 </td></tr></tbody></table><table border="1"><tbody><tr><th> Reactivo </th><th> Concentración </th><th> Fabricante </th><th> Número de catálogo </th></tr><tr><td> El pentobarbital sódico (solución de sodio Nembutol) </td><td> 70mg/kg </td><td> Ovación </td><td></td></tr><tr><td> Buprenorfina HCl </td><td> 0.1mg/kg </td><td> Bedford Laboratorios </td><td></td></tr><tr><td> Lactato de Ringer 250cc de inyección IV bolsa </td><td> Baxter </td><td></td><td></td></tr><tr><td> Aerrane (isoflurano) </td><td> El 99,9% </td><td> NLS Sanidad Animal </td><td> 105996 </td></tr><tr><td> Heparina sódica </td><td> 1000U </td><td> Abraxis </td><td></td></tr><tr><td> Cloruro de sodio bacteriostático </td><td> 0,9% </td><td> Hospira </td><td></td></tr><tr><td> El alcohol etílico </td><td> 70% </td><td> Fármaco-AAPER </td><td></td></tr><tr><td> Triadine povidona yodada (Betadine) </td><td></td><td> Tríada desechables </td><td></td></tr></tbody></table>

fixed volume or fixed pressure: a murine model of hemorrhagic shock

Es de conocimiento común que la pérdida severa de sangre y una lesión traumática puede dar lugar a una cascada de señalización de eventos perjudiciales a menudo resulta en la mortalidad. 1, 2, 3, 4, 5 Estos eventos de señalización también puede conducir a sepsis y / o disfunción orgánica múltiple (MOD ). 6, 7, 8, 9 Es fundamental entonces para investigar las causas de la función inmune suprimido y en detrimento de las cascadas de señalización a fin de desarrollar formas más efectivas de ayudar a los pacientes que sufren de lesiones traumáticas. 10 Este choque hemorrágico presión fija (SA) procedimiento, aunque técnicamente difícil, es un excelente recurso para la investigación de estas condiciones fisiopatológicas. 11, 12, 13 Avances en la evaluación de los sistemas biológicos, es decir, la biología de sistemas han permitido a la comunidad científica para comprender mejor las complejas redes fisiológicas y los patrones de comunicación celular. 14 El shock hemorrágico ha demostrado ser una herramienta vital para revelar los patrones de comunicación celular y su relación con la función inmune. 15, 16, 17, 18 Este procedimiento se puede dominar! Este procedimiento también se puede utilizar como una cantidad fija o un enfoque de presión fija. Se adaptó esta técnica en el modelo murino para mejorar la investigación en la función inmune innata y adaptativa. 19, 20, SA Debido a su pequeño tamaño en ratones 21 presenta retos únicos. Sin embargo, debido a las cepas de ratones disponibles, esta especie representa un recurso sin precedentes para el estudio de las respuestas biológicas. El modelo SA es un importante modelo para el estudio de los patrones de comunicación celular y las respuestas de los sistemas tales como sistemas mediadores hormonales e inflamatorios, y señales de peligro, es decir, DAMP y upregulation PAMP, ya que provoca respuestas distintas que se diferencian de otras formas de shock. 22, 23 , 24, 25 El desarrollo de cepas transgénicas murino y la inducción de agentes biológicos para inhibir la señalización específica han presentado valiosas oportunidades para esclarecer aún más nuestra comprensión de los de arriba a abajo la regulación de la transducción de señales después de una pérdida severa de sangre, es decir, SA y el trauma 26, 27 , 28, 29, 30. Existen numerosos métodos de resucitación (R) en asociación con la SA y el trauma. 31, 32, 33, 34 Un método de resucitación de volumen fijo de solución de Ringer lactato únicamente (LR), equivalente a tres veces el volumen de sangre derramada, se utiliza en este modelo para estudiar los mecanismos endógenos como la lesión de órganos a distancia y la inflamación sistémica. método 35, 36, 38 Este de la reanimación ha demostrado ser eficaz en la evaluación de los efectos de la SA y el trauma 38, 39.

Watch this Scientific Journal Video about Fixed Volume or Fixed Pressure: A Murine Model of Hemorrhagic Shock at JoVE.com

Fixed Volume or Fixed Pressure: A Murine Model of Hemorrhagic Shock

El modelo de shock hemorrágico ha sido un recurso confiable y reproducible para facilitar la identificación y comprensión de las cascadas de señalización asociados con la inflamación y daño de órganos diana tras un traumatismo. Este artículo proporciona una descripción paso a paso de los aspectos quirúrgicos y mecánicos asociados con el procedimiento experimental de choque hemorrágico en ratones.

Volumen fijo o fijado a presión: un modelo murino de shock hemorrágico

It is common knowledge that severe blood loss and traumatic injury can lead to a cascade of detrimental signaling events often resulting in mortality. 1, ...

fixed-volume-or-fixed-pressure-a-murine-model-of-hemorrhagic-shock

Research

JoVE Journal

Medicine

24.5K vistas.  University of Pittsburgh. El modelo de shock hemorrágico ha sido un recurso confiable y reproducible para facilitar la identificación y comprensión de las cascadas de señalización asociados con la inflamación y daño de órganos diana tras un traumatismo. Este artículo proporciona una descripción paso a paso de los aspectos quirúrgicos y mecánicos asociados con el procedimiento experimental de choque hemorrágico en ratones.

Video: Fixed Volume or Fixed Pressure: A Murine Model of Hemorrhagic Shock

Measurement of the Pressure-volume Curve in Mouse Lungs

In recent decades the mouse has become the primary animal model of a variety of lung diseases. In models of emphysema or fibrosis, the essential phenotypic changes are best assessed by measurement of the changes in lung elasticity. To best understand specific mechanisms underlying such pathologies in mice, it is essential to make functional measurements that can reflect the developing pathology. Although there are many ways to measure elasticity, the classical method is that of the total lung pressure-volume (PV) curve done over the whole range of lung volumes. This measurement has been made on adult lungs from nearly all mammalian species dating back almost 100 years, and such PV curves also played a major role in the discovery and understanding of the function of pulmonary surfactant in fetal lung development. Unfortunately, such total PV curves have not been widely reported in the mouse, despite the fact that they can provide useful information on the macroscopic effects of structural changes in the lung. Although partial PV curves measuring just the changes in lung volume are sometimes reported, without a measure of absolute volume, the nonlinear nature of the total PV curve makes these partial ones very difficult to interpret. In the present study, we describe a standardized way to measure the total PV curve. We have then tested the ability of these curves to detect changes in mouse lung structure in two common lung pathologies, emphysema and fibrosis. Results showed significant changes in several variables consistent with expected structural changes with these pathologies. This measurement of the lung PV curve in mice thus provides a straightforward means to monitor the progression of the pathophysiologic changes over time and the potential effect of therapeutic procedures.

Here we present a protocol to simply and reliably measure the lung pressure-volume curve in mice, showing that it is sufficiently sensitive to detect phenotypic parenchymal changes in two common lung pathologies, pulmonary fibrosis and emphysema. This metric provides a means to quantify the lung&#8217;s structural changes with developing pathology.

Medición de la curva de presión-volumen en mouse Pulmones

In recent decades the mouse has become the primary animal model of a variety of lung diseases. In models of emphysema or fibrosis, the essential ...

Investigación

Medicina

Scleral Cross-linking Using Riboflavin and Ultraviolet-A Radiation for Prevention of Axial Myopia in a Rabbit Model

Myopic individuals, especially those with severe myopia, are at higher-than-normal risk of cataract, glaucoma, retinal detachment and chorioretinal abnormalities. In addition, pathological myopia is a common irreversible cause of visual impairment and blindness1-3. Our study demonstrates the effect of scleral crosslinking using riboflavin and ultraviolet-A radiation on the development of axial myopia in a rabbit model. The axial length of the eyeball was measured by A-scan ultrasound in New Zealand white rabbits aged 13 days (male and female). The eye then underwent 360&#176; conjunctival peritomy with scleral crosslinking, followed by tarsorrhaphy. Axial elongation was induced in 13 day-old New Zealand rabbits by suturing their right eye eyelids (tarsorrhaphy). The eyes were divided into quadrants, and every quadrant had two scleral irradiation zones, each with an area of 0.2 cm&#178; and a radius of 4 mm. Crosslinking was performed by dropping 0.1% dextran-free riboflavin-5-phosphate onto the irradiation zones 20 sec before ultraviolet-A irradiation and every 20 sec during the 200 sec irradiation time. UVA radiation (370 nm) was applied perpendicular to the sclera at 57 mW/cm&#178; (total UVA light dose, 57 J/cm&#178;). Tarsorrhaphies were removed on day 55, followed by repeated axial length measurements. This study demonstrates that scleral crosslinking with riboflavin and ultraviolet-A radiation effectively prevents occlusion-induced axial elongation in a rabbit model.

We demonstrate the effect of scleral crosslinking with riboflavin and UVA on an axial elongation rabbit eye. Axial elongation was induced in 13 day-old New Zealand rabbits (male and female) by suturing their right eye eyelids (tarsorrhaphy).

Escleral Entrecruzamiento El uso de riboflavina y Ultravioleta-A de la radiación para la Prevención de la miopía axial en un modelo de conejo

Myopic individuals, especially those with severe myopia, are at higher-than-normal risk of cataract, glaucoma, retinal detachment and chorioretinal ...

Uncontrolled Hemorrhagic Shock Modeled via Liver Laceration in Mice with Real Time Hemodynamic Monitoring

Uncontrolled hemorrhage is an important cause of preventable deaths among trauma patients. We have developed a murine model of uncontrolled hemorrhage via a liver laceration that results in consistent blood loss, hemodynamic alterations, and survival.
Mice undergo a standardized resection of the left-middle lobe of the liver. They are allowed to bleed without mechanical intervention. Hemostatic agents can be administered as pre-treatment or rescue therapy depending on the interest of the investigator. During the time of hemorrhage, real-time hemodynamic monitoring via a left femoral arterial line is performed. Mice are then sacrificed, blood loss is quantified, blood is collected for further analysis, and organs are harvested for analysis of injury. Experimental design is described to allow for simultaneous testing of multiple animals.
Liver hemorrhage as a model of uncontrolled hemorrhage exists in the literature, primarily in rat and porcine models. Some of these models utilize hemodynamic monitoring or quantify blood loss but lack consistency. The present model incorporates quantification of blood loss, real-time hemodynamic monitoring in a murine model that offers the advantage of using transgenic lines and a high-throughput mechanism to further investigate the pathophysiologic mechanisms in uncontrolled hemorrhage.

Uncontrolled hemorrhage, an important cause of mortality among trauma patients, can be modeled using a standard liver laceration in a murine model. This model results in consistent blood loss, survival, and allows for testing hemostatic agents. This article provides the step-by-step process to perform this valuable model.

El shock hemorrágico no controlado se modela a través de la laceración hepática en ratones con monitorización hemodinámica en tiempo real

Uncontrolled hemorrhage is an important cause of preventable deaths among trauma patients. We have developed a murine model of uncontrolled hemorrhage via ...

Surgical Training for the Implantation of Neocortical Microelectrode Arrays Using a Formaldehyde-fixed Human Cadaver Model

This protocol describes a procedure to assist surgeons in training for the implantation of microelectrode arrays into the neocortex of the human brain. Recent technological progress has enabled the fabrication of microelectrode arrays that allow recording the activity of multiple individual neurons in the neocortex of the human brain. These arrays have the potential to bring unique insight onto the neuronal correlates of cerebral function in health and disease. Furthermore, the identification and decoding of volitional neuronal activity opens the possibility to establish brain-computer interfaces, and thus might help restore lost neurological functions. The implantation of neocortical microelectrode arrays is an invasive procedure requiring a supra-centimetric craniotomy and the exposure of the cortical surface; thus, the procedure must be performed by an adequately trained neurosurgeon. In order to provide an opportunity for surgical training, we designed a procedure based on a human cadaver model. The use of a formaldehyde-fixed human cadaver bypasses the practical, ethical and financial difficulties of surgical practice on animals (especially non-human primates) while preserving the macroscopic structure of the head, skull, meninges and cerebral surface and allowing realistic, operating room-like positioning and instrumentation. Furthermore, the use of a human cadaver is closer to clinical daily practice than any non-human model. The major drawbacks of the cadaveric simulation are the absence of cerebral pulsation and of blood and cerebrospinal fluid circulation. We suggest that a formaldehyde-fixed human cadaver model is an adequate, practical and cost-effective approach to ensure proper surgical training before implanting microelectrode arrays in the living human neocortex.

We designed a procedure in which a formaldehyde-fixed human cadaver is used to assist neurosurgeons in training for the implantation of microelectrode arrays into the neocortex of the human brain.

Formación quirúrgica para la implantación de microelectrodos Neocortical matrices usando un modelo de cadáver humano formaldehído-fija

This protocol describes a procedure to assist surgeons in training for the implantation of microelectrode arrays into the neocortex of the human brain. ...

Complete and Partial Aortic Occlusion for the Treatment of Hemorrhagic Shock in Swine

Hemorrhage remains the leading cause of preventable deaths in trauma. Endovascular management of non-compressible torso hemorrhage has been at the forefront of trauma care in recent years. Since complete aortic occlusion presents serious concerns, the concept of partial aortic occlusion has gained a growing attention. Here, we present a large animal model of hemorrhagic shock to investigate the effects of a novel partial aortic balloon occlusion catheter and compare it with a catheter that works on the principles of complete aortic occlusion. Swine are anesthetized and instrumented in order to conduct controlled fixed-volume hemorrhage, and hemodynamic and physiological parameters are monitored. Following hemorrhage, aortic balloon occlusion catheters are inserted and inflated in the supraceliac aorta for 60 min, during which the animals receive whole-blood resuscitation as 20% of the total blood volume (TBV). Following balloon deflation, the animals are monitored in a critical care setting for 4 h, during which they receive fluid resuscitation and vasopressors as needed. The partial aortic balloon occlusion demonstrated improved distal mean arterial pressures (MAPs) during the balloon inflation, decreased markers of ischemia, and decreased fluid resuscitation and vasopressor use. As swine physiology and homeostatic responses following hemorrhage have been well-documented and are like those in humans, a swine hemorrhagic shock model can be used to test various treatment strategies. In addition to treating hemorrhage, aortic balloon occlusion catheters have become popular for their role in cardiac arrest, cardiac and vascular surgery, and other high-risk elective surgical procedures.

Here, we present a protocol demonstrating a hemorrhagic shock model in swine that uses aortic occlusion as a bridge to definitive care in trauma. This model has application in testing a wide range of surgical and pharmacological therapeutic strategies.

Completa y parcial obstrucción aórtica para el tratamiento del choque hemorrágico en cerdos

Hemorrhage remains the leading cause of preventable deaths in trauma. Endovascular management of non-compressible torso hemorrhage has been at the ...

Standardized Hemorrhagic Shock Induction Guided by Cerebral Oximetry and Extended Hemodynamic Monitoring in Pigs

Hemorrhagic shock ranks among the main reasons for severe injury-related death. The loss of circulatory volume and oxygen carriers can lead to an insufficient oxygen supply and irreversible organ failure. The brain exerts only limited compensation capacities and is particularly at high risk of severe hypoxic damage.This article demonstrates the reproducible induction of life-threatening hemorrhagic shock in a porcine model by means of calculated blood withdrawal. We titrate shock induction guided by near-infrared spectroscopy&#160;and extended hemodynamic monitoring to display systemic circulatory failure, as well as cerebral microcirculatory oxygen depletion. In comparison to similar models that primarily focus on predefined removal volumes for shock induction, this approach highlights a titration by means of the resulting failure of macro- and microcirculation.

Hemorrhagic shock is a severe complication in seriously injured patients, which leads to life-threatening oxygen undersupply. We present a standardized method to induce hemorrhagic shock via blood withdrawal in pigs that is guided by hemodynamics and microcirculatory cerebral oxygenation.

Inducción de choque hemorrágico estandarizada guiada por oximetría cerebral y monitoreo hemodinámico extendido en cerdos

Hemorrhagic shock ranks among the main reasons for severe injury-related death. The loss of circulatory volume and oxygen carriers can lead to an ...

Closed Chest Biventricular Pressure-Volume Loop Recordings with Admittance Catheters in a Porcine Model

Pressure-volume (PV) loop recording enables the state-of-the-art investigation of load-independent variables of ventricular performance. Uni-ventricular evaluation is often performed in preclinical research. However, the right and left ventricles exert functional interdependence due to their parallel and serial connections, encouraging simultaneous evaluation of both ventricles. Furthermore, various pharmacological interventions may affect the ventricles and their preloads and afterloads differently. 
We describe our closed chest approach to admittance-based bi-ventricular PV loop recordings in a porcine model of acute right ventricular (RV) overload. We utilize minimally invasive techniques with all vascular accesses guided by ultrasound. PV catheters are positioned, under fluoroscopic guidance, to avoid thoracotomy in animals, as the closed chest approach maintains the relevant cardiopulmonary physiology. The admittance technology provides real-time PV loop recordings without the need for post-hoc processing. Furthermore, we explain some essential troubleshooting steps during critical timepoints of the presented procedure. 
The presented protocol is a reproducible and physiologically relevant approach to obtain a bi-ventricular cardiac PV loop recording in a large animal model. This can be applied to a large variety of cardiovascular animal research.

Here we present a closed chest approach to admittance-based bi-ventricular pressure-volume loop recordings in pigs with acute right ventricular dysfunction.

Registros cerrados de bucle de presión-volumen biventricular torácico con catéteres de admisión en un modelo porcino

Pressure-volume (PV) loop recording enables the state-of-the-art investigation of load-independent variables of ventricular performance. Uni-ventricular ...

Complete and Partial Resuscitative Endovascular Balloon Occlusion of the Aorta for Hemorrhagic Shock

Resuscitative endovascular balloon occlusion of the aorta (REBOA) devices grew out of a military-civilian partnership to develop new capabilities for hemorrhage control. With the advent of purpose-built devices, REBOA has become increasingly common in civilian trauma and acute care settings. Currently available REBOA catheters were designed as complete aortic occlusion devices. However, the therapeutic window for complete aortic occlusion is time-limited due to ischemia-reperfusion injury. The partial procedure allows blood flow past the level of occlusion while maintaining targeted proximal pressure, which has been shown to reduce distal ischemia and adjunctive resuscitation requirements in preclinical studies with prolonged occlusion times as compared to traditional complete occlusion.
pREBOA-PRO is the first catheter designed to enable partial and complete aortic occlusion and is currently in limited market release at seven Level I trauma centers in North America. This paper will focus on procedural considerations for REBOA, including patient selection criteria and a comparison of complete and partial aortic occlusion in a simulator, along with highlighting critical steps to improve clinical outcomes. Additionally, this paper reviews a contrast-enhanced CT scan from a trauma patient that shows distal perfusion after 2 h of partial aortic occlusion using this newly designed catheter and discusses representative results from the limited market release to highlight the profound effect of technological innovation on outcomes in vascular emergencies.

A commercial catheter was designed to facilitate true partial resuscitative endovascular balloon occlusion of the aorta (REBOA) and address the complications associated with complete aortic occlusion. Initial clinical reports indicate that partial REBOA improves transition to reperfusion, reduction of distal ischemia, and extension of safe occlusion time compared to complete occlusion.

Oclusión completa y parcial con balón endovascular de reanimación de la aorta para el shock hemorrágico

Resuscitative endovascular balloon occlusion of the aorta (REBOA) devices grew out of a military-civilian partnership to develop new capabilities for ...

Description of a Swine Infant Model of Volume-Controlled Hemorrhagic Shock

Hemorrhagic shock is a leading cause of morbidity and mortality in pediatric patients. Interpretation of the clinical indicators validated in adults to guide resuscitation and comparison between different therapies is difficult in children due to the inherent heterogeneity of this population. As a result, compared to adults, appropriate management of pediatric hemorrhagic shock is still not well established. In addition, the scarcity of pediatric patients with hemorrhagic shock precludes the development of clinically relevant studies. For this reason, an experimental pediatric animal model is necessary to study the effects of hemorrhage in children as well as their response to different therapies. We present an infant animal model of volume-controlled hemorrhagic shock in anesthetized young pigs. Hemorrhage is induced by withdrawing a previously calculated blood volume, and the pig is subsequently monitored and resuscitated with different therapies. Here, we describe a precise and highly reproducible model of hemorrhagic shock in immature swine. The model yields hemodynamic data that characterizes compensatory mechanisms that are activated in response to severe hemorrhage.

This article aims to provide researchers with a detailed and accessible guide to set up an infant porcine model of hemorrhagic shock.

Descripción de un modelo de lactante porcino de shock hemorrágico controlado por volumen

Hemorrhagic shock is a leading cause of morbidity and mortality in pediatric patients. Interpretation of the clinical indicators validated in adults to ...

Inducción dosis-dependiente de la endotoxemia en cerdos mediante infusión de LPS

Lipopolysaccharide Infusion as a Porcine Endotoxemic Shock Model

Sepsis and septic shock are frequently encountered in patients treated in intensive care units (ICUs) and are among the leading causes of death in these patients. It is caused by a dysregulated immune response to an infection. Even with optimized treatment, mortality rates remain high, which makes further insights into the pathophysiology and new treatment options necessary. Lipopolysaccharide (LPS) is a component of the cell membrane of gram-negative bacteria, which are often responsible for infections causing sepsis and septic shock. 
The severity and high mortality of sepsis and septic shock make standardized experimental studies in humans impossible. Thus, an animal model is needed for further studies. The pig is especially well suited for this purpose as it closely resembles humans in anatomy, physiology, and size. 
This protocol provides an experimental model for endotoxemic shock in pigs by LPS infusion. We were able to reliably induce changes frequently observed in septic shock patients, including hemodynamic instability, respiratory failure, and acidosis. This will allow researchers to gain valuable insight into this highly relevant condition and evaluate new therapeutic approaches in an experimental setting.

Autor destacado: Inducción de shock endotoxémico experimental en cerdos para el estudio de la insuficiencia hemodinámica y respiratoria

We provide a protocol for an experimental endotoxemic shock model in pigs by infusion of lipopolysaccharide.

Infusión de lipopolisacáridos como modelo de choque endotoxémico porcino

Sepsis and septic shock are frequently encountered in patients treated in intensive care units (ICUs) and are among the leading causes of death in these ...