An exploratory study investigating the effect of targeted hyperoxemia in a randomized controlled trial in a long-term resuscitated model of combined acute subdural hematoma and hemorrhagic shock in cardiovascular healthy pigs.
Thomas Datzmann, Franziska Münz, Andrea Hoffmann, Elena Moehrke, Martha Binzenhöfer, Michael Gröger, Thomas Kapapa, René Mathieu, Simon Mayer, Fabian Zink, Holger Gässler, Eva-Maria Wolfschmitt, Melanie Hogg, Tamara Merz, Enrico Calzia, Peter Radermacher, David Alexander Christian Messerer
Author Information
Thomas Datzmann: Institute for Anesthesiological Pathophysiology and Process Engineering, Ulm University, Ulm, Germany.
Franziska Münz: Institute for Anesthesiological Pathophysiology and Process Engineering, Ulm University, Ulm, Germany.
Andrea Hoffmann: Institute for Anesthesiological Pathophysiology and Process Engineering, Ulm University, Ulm, Germany.
Elena Moehrke: Institute for Anesthesiological Pathophysiology and Process Engineering, Ulm University, Ulm, Germany.
Martha Binzenhöfer: Institute for Anesthesiological Pathophysiology and Process Engineering, Ulm University, Ulm, Germany.
Michael Gröger: Institute for Anesthesiological Pathophysiology and Process Engineering, Ulm University, Ulm, Germany.
Thomas Kapapa: Department of Neurosurgery, University Hospital Ulm, Ulm, Germany.
René Mathieu: Department of Neurosurgery, German Federal Armed Forces Hospital Ulm, Ulm, Germany.
Simon Mayer: Department of Neurosurgery, German Federal Armed Forces Hospital Ulm, Ulm, Germany.
Fabian Zink: Institute for Anesthesiological Pathophysiology and Process Engineering, Ulm University, Ulm, Germany.
Holger Gässler: Department of Anesthesiology, Intensive Care Medicine, Emergency Medicine and Pain Therapy, German Armed Forces Hospital Ulm, Ulm, Germany.
Eva-Maria Wolfschmitt: Institute for Anesthesiological Pathophysiology and Process Engineering, Ulm University, Ulm, Germany.
Melanie Hogg: Institute for Anesthesiological Pathophysiology and Process Engineering, Ulm University, Ulm, Germany.
Tamara Merz: Institute for Anesthesiological Pathophysiology and Process Engineering, Ulm University, Ulm, Germany.
Enrico Calzia: Institute for Anesthesiological Pathophysiology and Process Engineering, Ulm University, Ulm, Germany.
Peter Radermacher: Institute for Anesthesiological Pathophysiology and Process Engineering, Ulm University, Ulm, Germany.
David Alexander Christian Messerer: Institute for Anesthesiological Pathophysiology and Process Engineering, Ulm University, Ulm, Germany.
Severe physical injuries and associated traumatic brain injury and/or hemorrhagic shock (HS) remain leading causes of death worldwide, aggravated by accompanying extensive inflammation. Retrospective clinical data indicated an association between mild hyperoxemia and improved survival and outcome. However, corresponding prospective clinical data, including long-term resuscutation, are scarce. Therefore, the present study explored the effect of mild hyperoxemia for 24 hours in a prospective randomized controlled trial in a long-term resuscitated model of combined acute subdural hematoma (ASDH) and HS. ASDH was induced by injecting 0.1 ml × kg autologous blood into the subdural space and HS was triggered by passive removal of blood. After 2 hours, the animals received full resuscitation, including retransfusion of the shed blood and vasopressor support. During the first 24 hours, the animals underwent targeted hyperoxemia (PO = 200 - 250 mmHg) or normoxemia (PO = 80 - 120 mmHg) with a total observation period of 55 hours after the initiation of ASDH and HS. Survival, cardiocirculatory stability, and demand for vasopressor support were comparable between both groups. Likewise, humoral markers of brain injury and systemic inflammation were similar. Multimodal brain monitoring, including microdialysis and partial pressure of O in brain tissue, did not show significant differences either, despite a significantly better outcome regarding the modified Glasgow Coma Scale 24 hours after shock that favors hyperoxemia. In summary, the present study reports no deleterious and few beneficial effects of mild targeted hyperoxemia in a clinically relevant model of ASDH and HS with long-term resuscitation in otherwise healthy pigs. Further beneficial effects on neurological function were probably missed due to the high mortality in both experimental groups. The present study remains exploratory due to the unavailability of an a priori power calculation resulting from the lack of necessary data.
