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

Dette arbejde er støttet af midler fra den amerikanske hær, Medical Research og Materiel Kommando, Combat Casualty Care Program. Vi takker LTC Kevin S. Akers, MD og Ms. Kristen R. Lye for deres bistand i at gøre videoen.

Forud for enhver menneskelig procedure, skal den institutionelle Review Board (IRB) godkende protokollen. Den protokol, der anvendes i denne undersøgelse blev godkendt af den amerikanske hær Medical Research og Materiel Kommando IRB. Protokollen er designet til at demonstrere de fysiologiske reaktioner i erstatning til en gradvis reduktion i det centrale blodvolumen svarer til den opleves af personer under igangværende blødning i et kontrolleret og reproducerbar laboratorium indstilling. Laboratoriet Rumtemperaturen styres ved 23-25 ​...

<ol>
	<li>Convertino, V. A., Wirt, M. D., Glenn, J. P., Lein, B. C. <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:+a+review+of+the+underlying+physiology.">The compensatory reserve for early and accurate prediction of hemodynamic compromise: a review of the underlying physiology.</a> Shock. 45 (6), 580-590 (2016).</li><li>Eastridge, B. 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=Death+on+the+battlefield+(2001-2011):+Implications+for+the+future+of+combat+casualty+care.">Death on the battlefield (2001-2011): Implications for the future of combat casualty care.</a> Journal of Trauma and Acute Care Surgery. 73 (6), S431-S437 (2012).</li><li>Orlinsky, M., Shoemaker, W., Reis, E. D., Kerstein, M. 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A., Grudic, G., Mulligan, J., Moulton, S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Estimation+of+individual-specific+progression+to+impending+cardiovascular+instability+using+arterial+waveforms.">Estimation of individual-specific progression to impending cardiovascular instability using arterial waveforms.</a> J. Appl. Physiol(Bethesda, Md :1985). 115 (8), 1196-1202 (2013).</li><li>Convertino, V. 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=Individual-specific,+beat-to-beat+trending+of+significant+human+blood+loss:+the+compensatory+reserve.">Individual-specific, beat-to-beat trending of significant human blood loss: the compensatory reserve.</a> Shock. 44 (Supplement 1), 27-32 (2015).</li><li>Cooke, W. H., Ryan, K. L., 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=Lower+body+negative+pressure+as+a+model+to+study+progression+to+acute+hemorrhagic+shock+in+humans.">Lower body negative pressure as a model to study progression to acute hemorrhagic shock in humans.</a> J. Appl. Physiol. 96, 1249-1261 (2004).</li><li>Convertino, V. 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=Inspiratory+resistance+maintains+arterial+pressure+during+central+hypovolemia:+implications+for+treatment+of+patients+with+severe+hemorrhage.">Inspiratory resistance maintains arterial pressure during central hypovolemia: implications for treatment of patients with severe hemorrhage.</a> Crit Care Med. 35 (4), 1145-1152 (2007).</li><li>Carter, R., Hinojosa-Laborde, C., 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=Variability+in+integration+of+mechanisms+associated+with+high+tolerance+to+progressive+reductions+in+central+blood+volume:+the+compensatory+reserve.">Variability in integration of mechanisms associated with high tolerance to progressive reductions in central blood volume: the compensatory reserve.</a> Physiol Reports. 4 (1), (2016).</li><li>Convertino, V. A., Sather, T. M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Vasoactive+neuroendocrine+responses+associated+with+tolerance+to+lower+body+negative+pressure+in+humans.">Vasoactive neuroendocrine responses associated with tolerance to lower body negative pressure in humans.</a> Clin. Physiol. 20, 177-184 (2000).</li><li>Convertino, V. 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. 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Brug LBNP at forårsage progressive og vedvarende reduktioner i det centrale blodvolumen, var vi i stand til at fremkalde en typisk reaktion af hæmodynamisk dekompensation i emnet, kendetegnet ved en pludseligt indsættende hypotension og bradykardi (figur 7). Det er vigtigt at forstå, at den integrerede kompenserende reaktion på blødning er meget kompleks, 19 resulterer i betydelig individuel variation i tolerance over for blodtab. 1 Som sådan nogle personer har relativt resp...

Den vigtigste funktion af det kardiovaskulære system er styringen af ​​passende perfusion (blodgennemstrømning og ilttilførsel) til alle væv i kroppen gennem homeostatiske regulering af arterielt blodtryk. Forskellige mekanismer for kompensation (fx autonome nervesystem aktivitet, hjertefrekvens og kontraktilitet, venøst tilbageløb, vasokonstriktion, respiration) bidrager til at opretholde normale fysiologiske niveauer af ilt i vævene. 1 Reduktioner i cirkulerende blodvolumen som dem forårsaget af blødning kan kompromittere evnen af ​​cardiovaskulære kompenserende mekanismer og i sidste ende føre til lavt arterieblodtryk, alvorlig hypoxi, og cirkulatorisk shock, der kan være dødelig. Kredsløbsshock forårsaget af alvorlig blødning (dvs. hæmoragisk shock) er en førende årsag til dødsfald på grund af traumer. 2 Et af de mest udfordrende aspekter ved at forhindre en patient i at udvikle shock er voresmanglende evne til at erkende sin tidlige debut. Tidlig og nøjagtig vurdering af progressionen mod udviklingen af chok i øjeblikket er begrænset i den kliniske omgivelser ved hjælp af teknologier (dvs. medicinske monitorer), som giver målinger af vitale tegn, der ændres meget lidt i de tidlige stadier af blodtab på grund af kroppens mange kompenserende mekanismer til at regulere blodtrykket. 3-6 Som sådan evnen til at måle den samlede sum af kroppens reserve til at kompensere for blodtab repræsenterer den mest nøjagtig afspejling af vævsperfusion tilstand og risikoen for at udvikle shock. 1 Denne reserve kaldes . kompenserende reserve, der kan præcist vurderes ved tidstro målinger af ændringer i træk af det arterielle bølgeform en Udtømning af den kompenserende reserve replikerer terminalen kardiovaskulær ustabilitet observeret hos kritisk syge patienter med pludseligt indsættende hypotension; en tilstand kendt som hæmodynamisk decompensation. 7 Forholdet mellem udnyttelsen af den kompenserende reserve og regulering af blodtrykket under løbende blodtab hos mennesker kan påvises i laboratoriet ved hjælp af et omfattende sæt af fysiologiske målinger (f.eks blodtryk, puls, arterieblod iltmætning, slagvolumen, minutvolumen, vaskulær modstand, respirationsfrekvens, puls karakter, mental tilstand, end-tidal CO2, væv ilt), som standard fysiologisk overvågning under kontinuerlig progressive reduktioner i det centrale blodvolumen ligner dem, der opstår under blødning. Sænket centrale blodvolumen kan induceres ikke-invasivt med progressive stigninger i Nedre Krop Negative Pressure (LBNP). 8 Brug denne kombination af fysiologiske målinger og LBNP, den konceptuelle forståelse af, hvordan at vurdere kroppens evne til at kompensere for nedsat blodvolumen central nemt kan være dæmonercentreret. Denne undersøgelse viser prelab forberedelse, demonstration af kompenserende reaktion i forhold til andre fysiologiske reaktioner under simuleret blødning, og postlab evaluering af resultater. De eksperimentelle teknikker, der er nødvendige for at foretage målinger kompenserende reserve demonstreret i et menneske frivillig.

<table border="1" fo:keep-together.within-page="1" fo:keep-with-next.within-page="always">
	<tbody>
		<tr>
			<td>Dynamic Research Evaluation Workstation (DREW) data acquisition syetem</td>
			<td>NA</td>
			<td>NA</td>
			<td>Custom Built by ISR personnel.&#160; 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 1000 Hz.</td>
		</tr>
		<tr>
			<td>Finometer</td>
			<td>Finapress Medical Systems (FMS)</td>
			<td>Model 1</td>
			<td>Device that provides non-invasive, continuous measurements of brachial artery blood pressure and arterial oxygen saturation (SpO2) 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&#160; end tidal CO2 and respiration rate</td>
		</tr>
		<tr>
			<td>CipherOX&#160;</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 CO2 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

Blødning er den førende årsag til traume-relaterede dødsfald, dels fordi tidlig diagnosticering af sværhedsgraden af ​​blodtab er vanskelig. Vurdering af hemorrhaging patienter er vanskelig, fordi de nuværende kliniske værktøjer giver foranstaltninger af vitale tegn, der forbliver stabil under de tidlige stadier af blødning på grund af kompenserende mekanismer. Der er derfor et behov for at forstå og måle den totale integration af mekanismer, som kompenserer for nedsat blodvolumen cirkulerer, og hvordan de ændres under igangværende progressiv blødning. Kroppens reserve for at kompensere for reduceret blodvolumen cirkulerer kaldes &quot;kompenserende reserve«. Den kompenserende reserve kan præcist vurderes med real-time målinger af ændringer i de elementer i det arterielle bølgeform målt ved brug af en høj-drevne computer. Lower Krop Undertryksteknologier (LBNP) har vist sig at simulere mange af de fysiologiske reaktioner hos mennesker er forbundet med blødning,og benyttes til at undersøge den kompenserende reaktion på blødning. Formålet med denne undersøgelse er at demonstrere, hvordan kompenserende reserve vurderes under progressive reduktioner i det centrale blodvolumen med LBNP som en simulering af blødning.

Den LBNP procedure forårsager en reduktion i lufttrykket omkring den nedre torso og ben. Da dette vakuum er progressivt, at skift blodvolumen fra hovedet og overkroppen til den nederste del af kroppen skabe en tilstand af central hypovolæmi. Den gradvise reduktion i det centrale blodvolumen (dvs. LBNP) frembringer betydelige ændringer i de elementer i det arterielle bølgeform målt med den infrarøde finger photoplethysmograph (figur 5). Den kompenserende Re...

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

Formålet med denne protokol er at demonstrere teknikkerne til måling af kompenserende reaktioner på reduceret blodvolumen central hjælp underkrop undertryk som en ikke-invasiv eksperimentel model af den menneskelige blødning, som kan bruges til at bestemme den samlede integration af kompenserende mekanismer til volumen underskud blod hos mennesker .

Integrerede Kompenserende respons i et menneske Model of Blødning

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

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Stem Cell Transplantation in an in vitro Simulated Ischemia/Reperfusion Model

Stem Cell Transplantation in an in vitro Simulated Ischemia/Reperfusion Model

Stamcelletransplantation i en In vitro Simuleret Iskæmi / reperfusion Model

Stem cell transplantation protocols are finding their way into clinical practice1,2,3. Getting better results, making the protocols more robust, and ...

A Low Mortality Rat Model to Assess Delayed Cerebral Vasospasm After Experimental Subarachnoid Hemorrhage

En lav dødelighed Rat model til at vurdere Forsinket cerebral vasospasme efter eksperimentel subarachnoid blødning

Objective: To characterize and establish a reproducible model that demonstrates delayed cerebral vasospasm after aneurysmal subarachnoid hemorrhage (SAH) ...

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

Modellering intracerebral blødning i mus: Injektion af autologt blod eller bakteriel collagenase

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

A Murine Model of Subarachnoid Hemorrhage

En murin model af subarachnoid blødning

In this video publication a standardized mouse model of subarachnoid  hemorrhage (SAH) is presented. Bleeding is induced by endovascular Circle of  Willis ...

Excitotoxic Stimulation of Brain Microslices as an In vitro Model of Stroke

Excitotoxic Stimulation of Brain Microslices as an In vitro Model of Stroke

Excitotoksiske Stimulering af Brain Microslices som en<em&gt; In vitro</em&gt; Model of Stroke

Examining molecular mechanisms involved in neuropathological conditions, such as ischemic stroke, can be difficult when using whole animal systems. As ...

Urinary Bladder Distention Evoked Visceromotor Responses as a Model for Bladder Pain in Mice

Urinblæren Udspilning Evoked Visceromotor Responses som en model for blæresmerter i mus

Approximately 3-8 million people in the United States suffer from interstitial cystitis/bladder pain syndrome (IC/BPS), a debilitating condition ...

The Rabbit Blood-shunt Model for the Study of Acute and Late Sequelae of Subarachnoid Hemorrhage: Technical Aspects

The Rabbit Blood-shunt model for studiet af akut og senfølger af subaraknoidalblødning: tekniske forhold

Early brain injury and delayed cerebral vasospasm both contribute to unfavorable outcomes after subarachnoid hemorrhage (SAH). Reproducible and ...

Mouse Pneumonectomy Model of Compensatory Lung Growth

Mus Pneumonectomy Model af kompenserende Lung Vækst

In humans, disrupted repair and remodeling of injured lung contributes to a host of acute and chronic lung disorders which may ultimately lead to ...

Pre-clinical Orthotopic Murine Model of Human Prostate Cancer

Prækliniske ortotopisk Murine Model of Human Prostata Cancer

To study the multifaceted biology of prostate cancer, pre-clinical in vivo models offer a range of options to uncover critical biological information ...

Induction of Accelerated Atherosclerosis in Mice: The "Wire-Injury" Model

Induktion af accelereret åreforkalkning i Mus: Den "Wire-Skade" Model

Atherosclerosis is a proliferative fibro-inflammatory disease developing in the arterial wall, inducing a deficient blood flow or a lack of blood flow. ...