Name: integrated compensatory responses in a human model of hemorrhage
Uploaded: 2016-11-20T15:00:00.000+00:00
Duration: 7 min 57 s
Description: Watch this Scientific Journal Video about Integrated Compensatory Responses in a Human Model of Hemorrhage at JoVE.com

이 작품은 미국 육군, 의료 연구 및 물자 사령부, 전투 사상자 케어 프로그램에서 자금을 지원합니다. 우리는 비디오를 만드는 그들의 도움을 LTC 케빈 S. 에이커 스, MD 및 양 크리스틴 R. 잿물 감사합니다.

이전에 어떤 인간의 절차, 제도 심의위원회 (IRB)는 프로토콜을 승인해야합니다. 이 연구에 사용 된 프로토콜은 미국 육군 의료 연구 및 물자 명령 IRB 승인을 받았다. 프로토콜이 조절되고 재현 실험실 환경에서 지속적인 출혈시 개인에 의해 경험 한 것과 유사한 중앙 혈액량의 점진적인 감소를 보상 생리적 반응을 입증하기 위해 설계된다. 25 ℃ - 실험실 실온 23에서 제어된다. 1. 장비 준비 <ol><li> 장비 및 예열 및 교정을 필요로하는 장치의 전원을 켭니다. 주 : 장비 및 장치 1 Hz에서 데이터를 기록하기위한 데이터 수집 시스템을 포함한다; 두 개의 분리 된 적외선 광 혈류 손가락 커프 센서 9-11하여 상완 동맥 혈압과 동맥혈 산소 포화도의 비 침습적 연속 측정 (SPO 2)를 제공하는 두 개의 분리 장치; capnogra호 기말 이산화탄소와 호흡을 측정하는 산도; 그리고 손가락 맥박 산소 측정기는 보상 적 준비를 측정하는 주변 타악기 동맥 파형을 획득합니다. </li><li> 실험 기간 동안의 시간을 표시하기 위해 사용되는 실험실 마스터 클록과 일치하도록 각 계측기에 타임 스탬프를 조정함으로써 내부 클럭과 기기 모두 동기화. </li></ol> 2. 제목 준비 <ol><li> 테스트에 앞서, 카페인, 알코올, 그리고 격렬한 운동 24 시간을 방지하고, 혈역학 적 부전은 메스꺼움을 유발하는 경우의 프로토콜 이전에 적어도 2 시간을 먹고 피하기 위해 주제를 지시한다. </li><li> 프로토콜의 개시 이전에, 의사가 피사체가 최소한의 건강 요구 사항을 충족하고, 제외 기준 (니코틴 사용, 고혈압, 자율 신경 장애, 또는 실신 에피소드의 역사)의 부재를 보장하기 위해 의료 검사 시험을 수행 할 수 있습니다. 임신에 대한 제외 기준이기 때문에참여, 연구의 날에 표준 소변 임신 테스트를 취할 여성 참가자가 필요합니다. 참고 : 피사체의 안전을 위해, 연구 의사는 고급 생명 유지에 인증 및 연구 기간 동안 존재한다. 완벽한 시설을 갖춘 &#39;응급 카트&#39;의식 상실 또는 LBNP 과정에서 발생하는 급성 심장 부정맥의 경우에 피사체의기도, 호흡 및 순환을 지원하기 위해 즉시 사용할 수 있습니다. </li><li> 절차에 대한 주제를 통보하고, 연구에 참여하는 서면 동의를 구하십시오. 참고 :이 연구의 목표는 심장 혈관 부전 (실신)의 발병 때까지 LBNP을 적용하는 것입니다 주제로 설명한다. 거기에이 점을 정의 심장 혈관 매개 변수는,이 심장 혈관 매개 변수가 관찰 될 때 LBNP이 종료 될 것이라고 설명한다. 그들은 또한 경험의 증상은 일반적으로 LBNP의 proce을하는 동안 실신과 관련된 수있는 주제를 알려틀리면. 이러한 현상이 발생하고 LBNP이 즉시 종료 될 경우 연구자에게 통지 주제를 지시한다. </li><li> 주제에 네오프렌 LBNP 스커트를 놓습니다. 스커트가 기밀 밀봉을 만들기 위해 허리와 몸통 주위에 아늑한되어 있는지 확인합니다. </li><li> LBNP 동안 제자리에 몸통을 확보하기 위해 고정 게시물을 벌리고있는 동안 LBNP 실의 침대에 누운 누워 주제를 지시한다. LBNP 노출시 하체를 긴장 주제를 지시한다. 기밀 밀봉을 생성하기 위해 챔버 개구에 네오프렌 스커트를 챔버로 침대를 슬라이딩과 연결하여 LBNP 챔버로 피사체를 고정합니다. 주 : LBNP 챔버 (0.1 mmHg로 내)의 정확한 기능을 제공 수동 또는 컴퓨터 화 된 프로파일 0 -100 mmHg로의 내부 압력을 제어한다. 챔버는 피사체의 자세를 지키기 위해 조절 안장을 포함한다. 명확한 플렉시 글라스 창은 피사체의 다리를 시각화 할 수 있습니다.기밀 밀봉가 피사체와 장골 (그림 1)의 수준에서 LBNP 실 착용 네오프렌 스커트에 의해 생성 될 때까지 조정 가능한 알루미늄 허리 보드 수 있습니다. </li><li> 장소 심전도 (ECG) 좌우 체액 - 쇄골 관절, 오른쪽에 전극이 심장 박동의 연속 측정을위한 수정 된 리드 II 구성 (그림 1) 낮은 리브 (4 총)을 떠났습니다. </li><li> 팔은 손을 심장 수준에서 지원되도록 조정, 휴식에 피사체의 팔을 놓습니다. 적절한 크기의 손가락 커프를 사용하면, 적외선 손가락 광 혈류를 배치 &#160; 혈압의 비 침습적 연속적인 박동 대 박동 측정 좌우 중간 손가락 장치. </li><li> 압력 모니터에 손가락 수갑을 연결합니다. 제조업체의 지침에 따라 장치 및 기록 혈액 압력을 보정합니다. (12)는 대상 정보를 입력 (연령, 성별, heig원하는 경우 HT, 체중)은 Modelflow 알고리즘에 의해 박출량, 심 박출량과 말초 혈관 저항의 계산 (추정)에 대한 적절한 가정을 활성화합니다. (13, 14)를 </li><li> 보상 예비 1,12- (그림 2)의 연속 측정을위한 오른쪽 검지 손가락에 손가락 맥박 산소 측정기를 놓습니다. </li><li> 주제에 비강 캐뉼라를 놓고 영감과 만기에 민감한 반사를 보장하기 위해 코를 통해 호흡 할 수있는 주제를 지시합니다. 코 공기 샘플링은 피사체가 개발 증상의 자기보고 자유롭게 이야기 할 수 있습니다. 호흡의 연속 측정을위한 capnograph에 비강 캐뉼라를 연결하고 갯벌 CO 2를 종료합니다. </li></ol> 3. LBNP 프로토콜을 수행 <ol><li> 데이터 수집 시스템의 &quot;시작&quot;버튼을 클릭하여 데이터 기록을 시작합니다. 5 분 녹음 기준 데이터. 중앙 hypovole의 첫 단계를 시작합니다미아 5 분 동안이 압력을 진공 모터를 켜고 -15 mmHg로에 부정적인 압력을 설정하고 유지하여. 그림 3은 프로토콜을 설명합니다. </li><li> -30 mmHg로에 LBNP을 증가시키고, 5 분 동안이 압력을 개최합니다. </li><li> -45 mmHg로에 LBNP을 증가시키고, 5 분 동안이 압력을 개최합니다. </li><li> -60 mmHg로에 LBNP을 증가시키고, 5 분 동안이 압력을 개최합니다. </li><li> -70 mmHg로에 LBNP을 증가시키고, 5 분 동안이 압력을 개최합니다. </li><li> (-100 mmHg로 LBNP에서 5 분) 프로토콜의 끝이나 혈역학 적 부전의 점까지 -10 mmHg로 매 5 분으로 LBNP 수준을 높이기 위해 계속합니다. LBNP 챔버에 압력 해제 버튼을 눌러 종료 LBNP. 참고 : 혈역학 적 부전은 수축기 동맥 80 mmHg로 아래의 압력, 또는 회색 아웃 (컬러 비전의 손실), 터널 비전, 발한, 오심 또는 현기증 (그림 4)와 같은 presyncopal 증상을보고 주제의 급격한 하락으로 식별됩니다. </li><li>LBNP의 중단 (postLBNP 복구) 후 10 분 동안의 데이터 수집 시스템에 기록 데이터를 계속한다. </li><li> 데이터 수집 시스템에서 &quot;중지&quot;버튼을 클릭하여 10 분간 회복 기간의 끝에서의 데이터 기록을 중지. </li><li> 피사체에서 모든 장비를 분리하고 LBNP 실에서 주제를 제거합니다. 실험실을 떠나기 전에 그들이 증상 무료 보장하기 위해 LBNP 플랫폼에서 사임 한 후 앉아 주제를 요청합니다. 이 연구가 완료되었습니다. </li><li> 보상 성 준비 지수 (CRI), 평균 동맥압 (MAP), 심장 박동, 그리고 SPO 2 값의 추출을위한 수집 시스템에서 다운로드 데이터 파일. 1,15,16 </li></ol>

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A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Use+of+advanced+machine-learning+techniques+for+noninvasive+monitoring+of+hemorrhage.">Use of advanced machine-learning techniques for noninvasive monitoring of hemorrhage.</a> J. Trauma. 71 (1 Suppl), S25-S32 (2011).</li><li>Convertino, V. A., Rickards, C. A., Ryan, K. L. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Autonomic+mechanisms+associated+with+heart+rate+and+vasoconstrictor+reserves.">Autonomic mechanisms associated with heart rate and vasoconstrictor reserves.</a> Clin. Auton. Res. 22, 123-130 (2012).</li><li>Rickards, C. A., Ryan, K. L., Cooke, W. H., Convertino, V. A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Tolerance+to+central+hypovolemia:+the+influence+of+oscillations+in+arterial+pressure+and+cerebral+blood+velocity.">Tolerance to central hypovolemia: the influence of oscillations in arterial pressure and cerebral blood velocity.</a> J. Appl. Physiol. 111 (4), 1048-1058 (2011).</li><li>Johnson, B. D., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Reductions+in+central+venous+pressure+by+lower+body+negative+pressure+of+blood+loss+elicit+similar+hemodynamic+responses.">Reductions in central venous pressure by lower body negative pressure of blood loss elicit similar hemodynamic responses.</a> J. Appl. Physiol. 117, 131-141 (2014).</li><li>van Helmond, N., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Coagulation+Changes+during+Lower+Body+Negative+Pressure+and+Blood+Loss+in+Humans.">Coagulation Changes during Lower Body Negative Pressure and Blood Loss in Humans.</a> Am. J. Physiol. Heart Circ. Physiol. 309, H1591-H1597 (2015).</li><li>Gerhardt, R., Berry, J., Blackbourne, L. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Analysis+of+life-saving+interventions+performed+by+out-of-hospital+combat+medical+personnel.">Analysis of life-saving interventions performed by out-of-hospital combat medical personnel.</a> J. Trauma. 71, S109-S113 (2011).</li><li>Pinsky, M. R. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Hemodynamic+evaluation+and+monitoring+in+the+ICU.">Hemodynamic evaluation and monitoring in the ICU.</a> Chest. 132 (6), 2020-2029 (2007).</li><li>Rivers, E., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Early+goal-directed+therapy+in+the+treatment+of+severe+sepsis+and+septic+shock.">Early goal-directed therapy in the treatment of severe sepsis and septic shock.</a> N.Engl.J.Med. , 1368-1377 (2001).</li><li>Rivers, E. P., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+influence+of+early+hemodynamic+optimization+on+biomarker+patterns+of+severe+sepsis+and+septic+shock.">The influence of early hemodynamic optimization on biomarker patterns of severe sepsis and septic shock.</a> Crit Care Med. 35 (9), 2016-2024 (2007).</li><li>Rivers, E. P., Coba, V., Whitmill, M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Early+goal-directed+therapy+in+severe+sepsis+and+septic+shock:+a+contemporary+review+of+the+literature.">Early goal-directed therapy in severe sepsis and septic shock: a contemporary review of the literature.</a> Curr Opin Anaesthesiol. 21 (2), 128-140 (2008).</li><li>Cap, A. P., Spinella, P. C., Borgman, M. A., Blackbourne, L. H., Perkins, J. G. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Timing+and+location+of+blood+product+transfusion+and+outcomes+in+massively+transfused+combat+casualties.">Timing and location of blood product transfusion and outcomes in massively transfused combat casualties.</a> J. Trauma. 73, S89-S94 (2012).</li><li>Spinella, P. C., Perkins, J. G., Grathwohl, K., Beekley, A., Holcomb, J. B. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Warm+fresh+whole+blood+is+independently+associated+iwth+improved+survival+for+patients+with+combat-related+traumatic+injuries.">Warm fresh whole blood is independently associated iwth improved survival for patients with combat-related traumatic injuries.</a> J. Trauma. 66, S69-S76 (2009).</li><li>Kragh, J., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Survival+with+emergency+tourniquet+use+to+stop+bleeding+in+major+limb+trauma.">Survival with emergency tourniquet use to stop bleeding in major limb trauma.</a> Ann Surgery. 249 (1), 1-7 (2009).</li><li>Chung, K. K., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Continous+renal+replacement+therapy+improves+survival+in+severly+burned+military+casualties+with+acute+kidney+injury.">Continous renal replacement therapy improves survival in severly burned military casualties with acute kidney injury.</a> J. Trauma. 64, S179-S187 (2008).</li><li>Stewart, C. L., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+compensatory+reserve+for+early+and+accurate+prediction+of+hemodynamic+compromise:+case+studies+for+clinical+utility+in+acute+care+and+physical+performance.">The compensatory reserve for early and accurate prediction of hemodynamic compromise: case studies for clinical utility in acute care and physical performance.</a> J Special Op. Med. 16, 6-13 (2016).</li></ol>

The authors declare that they have no competing financial interests. The views expressed herein are the private views of the authors and are not to be construed as representing those of the US Department of the Army or the US Department of Defense.

중앙 혈액량 진보적 지속적 감소를 야기 LBNP를 사용하여, 우리는 저혈압 및 서맥 (도 7)의 갑작스러운 발병을 특징으로 피사체의 혈역학 부전의 전형적인 반응을 유도 할 수 있었다. 혈액 손실에 대한 허용 오차에 상당한 개별 다양성의 결과로, 출혈로 통합 보상 응답이 매우 복잡 것을 이해하는 것이 19 중요합니다. (1) 다른 사람이 효과적으로 보상하지 않는 동안 따라...

심장 혈관 시스템의 가장 중요한 기능은 동맥 혈압의 항상성 조절을 통해 신체의 모든 조직에 충분한 혈류 (혈액 순환과 산소 공급)의 제어이다. 보상 다양한 메커니즘 (예를 들어, 자율 신경계의 활동, 심장 속도 및 수축력, 정맥 복귀 수축 호흡)은 조직에서 산소의 정상적인 생리 학적 수준을 유지하는 데 기여한다. (1) 감소 등의 출혈로 인한 이러한 타협 수 혈액 양의 심장 혈관 보상 메커니즘의 능력과 궁극적으로 치명적일 수있다 낮은 동맥 혈압, 심각한 조직의 저산소증,과 순환 쇼크로 이어집니다. 심한 출혈 (즉, 출혈성 쇼크)에 의한 순환 충격에 의한 외상 사망의 주요 원인이다.에서 환자를 방지하는 가장 어려운 측면이 하나의 충격을 개발하는 우리입니다무능력 초기 증상을 인식합니다. 쇼크의 발달을 향해 진행 초기에 정확한 평가는 현재 때문에 신체의 다양한 보상의 혈액 손실의 초기 단계에서 매우 작은 변화 생체 신호의 측정을 제공하는 기술 (예, 의료용 모니터)에 의해 임상에서 한정 혈압을 조절하는 메커니즘. 3-6과 같은 혈액 손실을 보상하기 위해 신체의 보호구의 총합을 측정하는 기능은 조직 관류 상태의 가장 정확하게 반영 충격 발생 위험을 나타낸다. (1)이 예비가 불려 . 정확하게 동맥 파형의 기능에 변화를 실시간으로 측정에 의해 평가 될 수 보상 준비금은 보상 예비 1 고갈은 저혈압의 갑작스런 발병과 비판적으로 아픈 환자에서 관찰 된 단말기 심장 혈관 불안정을 복제; 혈역학 적 데코로 알려진 조건mpensation. (7) 인간 지속적인 실혈시 보상 예비 혈압 조절의 이용 간의 관계 (생리적 측정치 광범위한 세트를 사용하여 실험실에서 입증 될 수있다 예를 들어, 혈압, 심박수, 동맥혈 산소 포화도, 스트로크 볼륨 출혈 중에 발생하는 것과 유사한 중앙 혈액량 연속 점진적인 감소 동안 표준 생리 학적 모니터링에 의해 제공되는 심 박출량, 혈관 저항, 호흡율, 펄스 특성, 정신 상태, 호 기말 CO 2, 조직 산소). 하강 중앙 혈액량은 하체 부압 점진적인 증가 (LBNP) 함께 비 침습적으로 유도 될 수있다.도 8 생리 학적 측정과 LBNP 쉽게 될 수 감소 중앙 혈액량을 보상하는 신체의 능력을 평가하는 방법의 개념을 이해할의 조합을 사용하여 악마보이는 것. 이 연구는 prelab 준비, 모의 출혈 동안 다른 생리적 반응과 관련하여 보상 응답의 시연 및 결과의 postlab 평가를 나타낸다. 보상 준비금의 측정을 위해 필요한 실험 기술은 인간의 자원 봉사에서 입증된다.

<table><tbody><tr><td>Dynamic Research Evaluation Workstation (DREW) data acquisition syetem</td><td>NA</td><td>NA</td><td>Custom Built by ISR personnel. The DREW allows for time synchronization of both digital and analog signal data collection from up to 16 independent instruments with a sampling rate of 1,000 Hz.</td></tr><tr><td>Finometer</td><td>Finapress Medical Systems (FMS)</td><td>Model 1</td><td>Device that provides noninvasive, continuous measurements of brachial artery blood pressure and arterial oxygen saturation (SpO&lt;sub&gt;2&lt;/sub&gt;) using two separate infrared finger photophlethymography cuff sensors.</td></tr><tr><td>BCI Capnocheck Plus</td><td>Smith Medical PM Inc.</td><td>9004</td><td>Capnograph used to measure end tidal CO&lt;sub&gt;2&lt;/sub&gt; and respiration rate</td></tr><tr><td>CipherOX&amp;nbsp;</td><td>Flashback Technologies Inc.</td><td>R200</td><td>Investigational device used to calculate Compensatory Reserve Index (CRI)</td></tr><tr><td>Nonin 9560 Pulse Oximeter</td><td>Nonin</td><td>9560</td><td>finger pulse oximeter</td></tr><tr><td>Lower Body Negative Pressure Chamber (LBNP)</td><td>NASA</td><td>79K32632-1</td><td>Custom Chamber built by NASA</td></tr><tr><td>ECG Biotach</td><td>Gould</td><td>13-6615-65</td><td>Electrocardiograph for measuring ECG</td></tr><tr><td>Nasal CO&lt;sub&gt;2&lt;/sub&gt; Sample Line</td><td>Salter Labs</td><td>REF 4000</td><td>Latex free nasal cannula for sampling expired air</td></tr></tbody></table>

integrated compensatory responses in a human model of hemorrhage

출혈 혈액 손실의 심각성을 조기 진단이 곤란하기 때문에 부분적 외상 관련 사망의 주요 원인이다. 현재 임상 도구 인해 보상 메커니즘 출혈의 초기 단계 동안에 안정하게 유지 생체 신호의 측정을 제공하기 때문에 출혈 환자의 평가가 곤란하다. 따라서, 이해 감소 순환 혈액량 그들이 어떻게 진행 프로그레시브 출혈시 변화를 보상기구의 전체 통합을 측정 할 필요가있다. 몸의 적립금이 감소 순환 혈액량을 보상하는 &#39;보상 준비금&#39;이라고합니다. 보상 용 예비 정확하게 고성능 컴퓨터를 이용하여 측정되는 동맥 파형의 특징의 변화를 실시간으로 측정하여 평가할 수있다. 하체 부압 (LBNP)의 출혈과 관련된 인체의 생리적 반응의 많은 시뮬레이션 나타났다및 출혈에 대한 보상 반응을 연구하는 데 사용됩니다. 이 연구의 목적은 출혈의 시뮬레이션으로 LBNP와 중앙 혈액 볼륨 점진적 감소하는 동안 평가하는 방법을 보상 예비 입증하는 것입니다.

LBNP 절차는 하부 몸통과 다리 주위의 공기 압력의 감소를 야기한다. 이 진공 점차 증가함에 따라, 상기 하부 본체의 머리와 상반신의 혈액량의 변화는 중앙의 저 혈량 상태를 생성한다. 중앙 혈액량의 점진적인 감소 (즉, LBNP)는 적외선 손가락 photoplethysmograph (도 5)로 측정 동맥 파형의 특성에 상당한 변화를 생성한다. 보상 성 준비 지수 (CRI)는 추정 된 보...

Watch this Scientific Journal Video about Integrated Compensatory Responses in a Human Model of Hemorrhage at JoVE.com

Integrated Compensatory Responses in a Human Model of Hemorrhage

이 프로토콜의 목적은 인간의 혈액량 적자 보상기구의 전체 통합을 정량화하는데 사용될 수있는 인간 출혈 비 침습적 실험 모델로 하체 부압을 사용하여 단축 된 중앙 혈액량을 보상 응답을 측정하는 방법을 보여주는 것이다 .

출혈의 인간 모델의 통합 보상 적 응답

Hemorrhage is the leading cause of trauma-related deaths, partly because early diagnosis of the severity of blood loss is difficult. Assessment of ...

integrated-compensatory-responses-in-a-human-model-of-hemorrhage

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12.4K 조회수.  JBSA Fort Sam Houston.  이 프로토콜의 목적은 인간의 혈액량 적자 보상기구의 전체 통합을 정량화하는데 사용될 수있는 인간 출혈 비 침습적 실험 모델로 하체 부압을 사용하여 단축 된 중앙 혈액량을 보상 응답을 측정하는 방법을 보여주는 것이다 . 

비디오: Integrated Compensatory Responses in a Human Model of Hemorrhage

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

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, 2, 3, 4, 5 These signaling events can also lead to sepsis and/or multiple organ dysfunction (MOD). 6, 7, 8, 9 It is critical then to investigate the causes of suppressed immune function and detrimental signaling cascades in order to develop more effective ways to help patients who suffer from traumatic injuries. 10 This fixed pressure Hemorrhagic Shock (HS) procedure, although technically challenging, is an excellent resource for investigation of these pathophysiologic conditions. 11, 12, 13 Advances in the assessment of biological systems, i.e. Systems Biology have enabled the scientific community to further understand complex physiologic networks and cellular communication patterns. 14 Hemorrhagic Shock has proven to be a vital tool for unveiling these cellular communication patterns as they relate to immune function. 15, 16, 17, 18 This procedure can be mastered! This procedure can also be used as either a fixed volume or fixed pressure approach. We adapted this technique in the murine model to enhance research in innate and adaptive immune function. 19, 20, 21 Due to their small size HS in mice presents unique challenges. However due to the many available mouse strains, this species represents an unparalleled resource for the study of the biologic responses. The HS model is an important model for studying cellular communication patterns and the responses of systems such as hormonal and inflammatory mediator systems, and danger signals, i.e. DAMP and PAMP upregulation as it elicits distinct responses that differ from other forms of shock. 22, 23, 24, 25 The development of transgenic murine strains and the induction of biologic agents to inhibit specific signaling have presented valuable opportunities to further elucidate our understanding of the up and down regulation of signal transduction after severe blood loss, i.e. HS and trauma 26, 27, 28, 29, 30. 
There are numerous resuscitation methods (R) in association with HS and trauma. 31, 32, 33, 34 A fixed volume resuscitation method of solely lactated ringer solution (LR), equal to three times the shed blood volume, is used in this model to study endogenous mechanisms such as remote organ injury and systemic inflammation. 35, 36, 38 This method of resuscitation is proven to be effective in evaluating the effects of HS and trauma 38, 39.

The Hemorrhagic Shock model has been a reliable and reproducible resource facilitating the identification and understanding of signaling cascades associated with inflammation and end-organ damage after trauma. This article provides a step-by-step description of surgical and mechanical aspects associated with the Hemorrhagic Shock experimental procedure in mice.

고정 볼륨 또는 고정 압력 : 출혈성 쇼크의 Murine 모델

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, ...

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Modeling Intracerebral Hemorrhage in Mice: Injection of Autologous Blood or Bacterial Collagenase 

Spontaneous intracerebral hemorrhage (ICH) defines a potentially life-threatening neurological malady that accounts for 10-15% of all stroke-related hospitalizations and for which no effective treatments are available to date1,2. Because of the heterogeneity of ICH in humans, various preclinical models are needed to thoroughly explore prospective therapeutic strategies3. Experimental ICH is commonly induced in rodents by intraparenchymal injection of either autologous blood or bacterial collagenase4. The appropriate model is selected based on the pathophysiology of hemorrhage induction and injury progression. The blood injection model mimics a rapidly progressing hemorrhage. Alternatively, bacterial collagenase enzymatically disrupts the basal lamina of brain capillaries, causing an active bleed that generally evolves over several hours5. Resultant perihematomal edema and neurofunctional deficits can be quantified from both models. In this study, we described and evaluated a modified double injection model of autologous whole blood6 as well as an ICH injection model of bacterial collagenase7, both of which target the basal ganglia (corpus striatum) of male CD-1 mice. We assessed neurofunctional deficits and brain edema at 24 and 72 hr after ICH induction. Intrastriatal injection of autologous blood (30 &mu;l) or bacterial collagenase (0.075U) caused reproducible neurofunctional deficits in mice and significantly increased brain edema at 24 and 72 hr after surgery (p&lt;0.05). In conclusion, both models yield consistent hemorrhagic infarcts and represent basic methods for preclinical ICH research.

Modeling Intracerebral Hemorrhage in Mice: Injection of Autologous Blood or Bacterial Collagenase

Clinically relevant animal models of intracerebral hemorrhage (ICH) are needed to extend our knowledge of hemorrhagic stroke and to examine novel therapeutic strategies. In this study, we describe and evaluate two ICH models that implement unilateral injections of either autologous whole blood or bacterial collagenase into the basal ganglia (corpus striatum) of mice.

마우스의 모델링 Intracerebral 출혈 : Autologous 혈액이나 세균 Collagenase의 주입

Spontaneous intracerebral hemorrhage (ICH) defines a potentially life-threatening neurological malady that accounts for 10-15% of all stroke-related ...

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.

실시간 혈류 역학 모니터링을 이용한 마우스의 간경화로 모델링 된 통제 할 수없는 출혈성 쇼크

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

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.

돼지에서 출혈 성 쇼크의 치료에 대 한 전체 및 부분 대동맥 폐색

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.

돼지의 뇌산소측정및 확장된 혈역학적 모니터링에 의해 유도된 표준화된 출혈성 쇼크 유도

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

Systems Analysis of the Neuroinflammatory and Hemodynamic Response to Traumatic Brain Injury

Mild traumatic brain injuries (mTBIs) are a significant public health problem. Repeated exposure to mTBI can lead to cumulative, long-lasting functional deficits. Numerous studies by our group and others have shown that mTBI stimulates cytokine expression and activates microglia, decreases cerebral blood flow and metabolism, and impairs cerebrovascular reactivity. Moreover, several works have reported an association between derangements in these neuroinflammatory and hemodynamic markers and cognitive impairments. Herein we detail methods to characterize the neuroinflammatory and hemodynamic tissue response to mTBI in mice. Specifically, we describe how to perform a weight-drop model of mTBI, how to longitudinally measure cerebral blood flow using a non-invasive optical technique called diffuse correlation spectroscopy, and how to perform a Luminex multiplexed immunoassay on brain tissue samples to quantify cytokines and immunomodulatory phospho-proteins (e.g., within the MAPK and NF&#954;B pathways) that respond to and regulate activity of microglia and other neural immune cells. Finally, we detail how to integrate these data using a multivariate systems analysis approach to understand the relationships between all of these variables. Understanding the relationships between these physiologic and molecular variables will ultimately enable us to identify mechanisms responsible for mTBI.

This protocol presents methods to characterize the neuroinflammatory and hemodynamic response to mild traumatic brain injury and to integrate these data as part of a multivariate systems analysis using partial least squares regression.

외상성 뇌 손상에 대한 신경 염증 및 혈역학 반응의 시스템 분석

Mild traumatic brain injuries (mTBIs) are a significant public health problem. Repeated exposure to mTBI can lead to cumulative, long-lasting functional ...

신경과학

A Preclinical Controlled Cortical Impact Model for Traumatic Hemorrhage Contusion and Neuroinflammation

Cerebral contusion is a severe medical problem affecting millions of people worldwide each year. There is an urgent need to understand the pathophysiological mechanism and to develop effective therapeutic strategy for this devastating neurological disorder. Intraparenchymal hemorrhage and post-traumatic inflammatory response induced by initial physical impact can aggravate microglia/macrophage activation and neuroinflammation which subsequently worsen brain pathology. We provide here a controlled cortical impact (CCI) protocol that can reproduce experimental cortical contusion in mice by using a pneumatic impactor system to deliver mechanical force with controllable magnitude and velocity onto the dural surface. This preclinical model allows researchers to induce moderately severe focal cerebral contusion in mice and to investigate a wide range of post-traumatic pathological progressions including hemorrhage contusion, microglia/macrophage activation, iron toxicity, axonal injury, as well as short-term and long-term neurobehavioral deficits. The present protocol can be useful for exploring the long-term effects of and potential interventions for cerebral contusion.

<meta charset="utf8"></head><body>외상성 출혈 타박상 및 신경염증에 대한 전임상 제어 피질 영향 모델

Intraparenchymal hemorrhage and neuroinflammation accompanied by cerebral contusion can trigger severe secondary brain injury. This protocol details a mouse controlled cortical impact (CCI) model allowing researchers to study hemorrhage contusion and post-traumatic immune responses and explore potential therapeutics.

외상성 출혈 타박상 및 신경염증에 대한 전임상 제어 피질 영향 모델

Cerebral contusion is a severe medical problem affecting millions of people worldwide each year. There is an urgent need to understand the ...

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.

체적 조절 출혈성 쇼크의 돼지 유아 모델에 대한 설명

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

쥐의 출혈성 쇼크 유도를 통한 혈관 캐뉼레이션

Developing a Clinically Relevant Hemorrhagic Shock Model in Rats

Over the recent decades, the development of animal models allowed us to better understand various pathologies and identify new treatments. Hemorrhagic shock, i.e., organ failure due to rapid loss of a large volume of blood, is associated with a highly complex pathophysiology involving several pathways. Numerous existing animal models of hemorrhagic shock strive to replicate what happens in humans, but these models have limits in terms of clinical relevance, reproducibility, or standardization. The aim of this study was to refine these models to develop a new model of hemorrhagic shock. Briefly, hemorrhagic shock was induced in male Wistar Han rats (11-13 weeks old) by a controlled exsanguination responsible for a drop in the mean arterial pressure. The next phase of 75 min was to maintain a low mean arterial blood pressure, between 32 mmHg and 38 mmHg, to trigger the pathophysiological pathways of hemorrhagic shock. The final phase of the protocol mimicked patient care with an administration of intravenous fluids, Ringer Lactate solution, to elevate the blood pressure. Lactate and behavioral scores were assessed 16 h after the protocol started, while hemodynamics parameters and plasmatic markers were evaluated 24 h after injury. Twenty-four hours post-hemorrhagic shock induction, the mean arterial and diastolic blood pressure were decreased in the hemorrhagic shock group (p&#160;&#60; 0.05). Heart rate and systolic blood pressure remained unchanged. All organ damage markers were increased with the hemorrhagic shock (p &#60; 0.05). The lactatemia and behavioral scores were increased compared to the sham group (p &#60; 0.05). In conclusion, we demonstrated that the protocol described here is a relevant model of hemorrhagic shock that can be used in subsequent studies, particularly to evaluate the therapeutic potential of new molecules.

저자 스포트라이트: 출혈성 쇼크 연구를 위한 혁신적인 치료 전략 개발

Hemorrhagic shock kills 1.9 million people worldwide every year. Small animals are frequently used as hemorrhagic shock models but are associated with issues of standardization, reproducibility, and clinical significance, thus limiting their relevance. This article describes developing a new clinically relevant hemorrhagic shock model in rats.

쥐에서 임상적으로 관련된 출혈성 쇼크 모델 개발

Over the recent decades, the development of animal models allowed us to better understand various pathologies and identify new treatments. Hemorrhagic ...

출혈의 인간 모델의 통합 보상 적 응답

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고정 볼륨 또는 고정 압력 : 출혈성 쇼크의 Murine 모델

마우스의 모델링 Intracerebral 출혈 : Autologous 혈액이나 세균 Collagenase의 주입

실시간 혈류 역학 모니터링을 이용한 마우스의 간경화로 모델링 된 통제 할 수없는 출혈성 쇼크

돼지에서 출혈 성 쇼크의 치료에 대 한 전체 및 부분 대동맥 폐색

돼지의 뇌산소측정및 확장된 혈역학적 모니터링에 의해 유도된 표준화된 출혈성 쇼크 유도

외상성 뇌 손상에 대한 신경 염증 및 혈역학 반응의 시스템 분석

외상성 출혈 타박상 및 신경염증에 대한 전임상 제어 피질 영향 모델

외상성 출혈 타박상 및 신경염증에 대한 전임상 제어 피질 영향 모델

체적 조절 출혈성 쇼크의 돼지 유아 모델에 대한 설명

쥐에서 임상적으로 관련된 출혈성 쇼크 모델 개발