The Experts below are selected from a list of 30 Experts worldwide ranked by ideXlab platform

Bernd Driessen - One of the best experts on this subject based on the ideXlab platform.

  • Does OxyVita, a new-generation Hemoglobin-based oxygen carrier, or oxyglobin acutely interfere with coagulation compared with normal saline or 6% hetastarch? An ex vivo thromboelastography study.
    Journal of Cardiothoracic and Vascular Anesthesia, 2008
    Co-Authors: Jonathan S. Jahr, David L. Weeks, Jennifer C. Lim, Anthony W. Butch, Robert A Gunther, Poonam Desai, Bernd Driessen
    Abstract:

    Objectives: Because hetastarches have deleterious effects on coagulation that increase with molecular weight (MWt), risk of coagulopathy associated with a high MWt Hemoglobin-based oxygen carrier (HBOC) was studied. Design: Preliminary laboratory study of donor blood using thromboelastography (TEG). Setting: University laboratory. Participants: Volunteer donor blood. Interventions: Experiments simulated hemodilution during clinical resuscitation of hemorrhagic shock with varying doses of HBOCs. Coagulopathy related to 1:11, 1:5, 1:2, or 1:1 dilution of whole blood with normal saline, 6% hetastarch (670 kilodaltons [kD]), Hemoglobin Glutamer-200 (HBOC-200, 200 kD), or OxyVita (OXYVITA Inc, New Windsor, NY) (a new-generation, zero-link polymerized bovine Hemoglobin-based oxygen carrier, 33 megadaltons) were analyzed. Measurements and Main Results: At 2 lower levels of hemodilution, hetastarch, HBOC-200, and OxyVita produced equivalent reductions in maximum clot strength (TEG-MA and TEG-G) that reached statistical significance compared with whole blood and normal saline. At 2 higher dilutions, OxyVita and HBOC-200 impaired maximum clot strength compared with whole blood, normal saline, and hetastarch. Dilution with hetastarch had a greater effect on clot propagation (K and α) than either HBOC. Conclusions: OxyVita and HBOC-200, HBOCs with different MWt, had similar effects on coagulation as measured by TEG. The impairment of coagulation by HBOCs and hetastarch occurred at doses corresponding to 12 mL/kg or a blood volume replacement of 17%. The use of HBOCs at doses corresponding to 23 mL/kg or a blood volume replacement of 33% significantly decreased coagulation to levels associated with increased clinical bleeding in this preliminary study. Minimal coagulopathic effects are expected with use of OxyVita at the manufacturer’s anticipated effective dose of 10 g or 2 to 3 mL/kg.

  • effects of isovolemic resuscitation with Hemoglobin based oxygen carrier Hemoglobin Glutamer 200 bovine on systemic and mesenteric perfusion and oxygenation in a canine model of hemorrhagic shock a comparison with 6 hetastarch solution and shed blood
    Veterinary Anaesthesia and Analgesia, 2006
    Co-Authors: Jonathan S. Jahr, Bernd Driessen, Fedor Lurie, R A Gunther
    Abstract:

    Objective To study Hemoglobin Glutamer-200 bovine (Hb-200), 6% hetastarch (HES) and shed whole blood (WB) resuscitation in canine hemorrhagic shock. Study design Prospective laboratory investigation. Animals Twelve adult dogs [29 ± 1 kg (mean ± SD)]. Methods Anesthetized dogs were instrumented for recording systemic and mesenteric hemodynamic parameters and withdrawal of arterial, mixed and mesenteric venous blood, in which hematological, oxygenation, blood gas and acid–bases variables were determined. Recordings were made before [baseline (BL)], after 1 hour of hypovolemia and immediately and 3 hours post-resuscitation with 30 mL kg−1 of either Hb-200, HES, or WB. Results Blood withdrawal (average 34 ± 2 mL kg−1) caused significant hemodynamic changes, metabolic acidosis and hyperlactatemia characteristic for hemorrhagic shock. Only WB transfusion restored all variables. Hemoglobin Glutamer-200 bovine infusion returned most hemodynamic parameters including cardiac output and mesenteric arterial blood flow to BL but increased mean arterial pressure above BL (p < 0.05). However, Hb-200 failed to restore total Hb and arterial oxygen content (CaO2), leaving systemic (DO2I) and mesenteric O2 delivery (DO2Im) below BL (p < 0.05). Nevertheless, acid–base variables recovered completely after Hb-200 resuscitation, and met-Hemoglobin (Met-Hb) levels increased (p < 0.05). Hetastarch resuscitation returned hemodynamic variables to or above BL but further decreased total Hb and CaO2, preventing recovery of sDO2I and mDO2I (p < 0.05). Thus, systemic and mesenteric O2 extraction stayed above BL (p < 0.05) while acid–base variables recovered to BL, although slower than in Hb-200 and WB groups (p < 0.05). Conclusions and clinical relevance Resuscitation with Hb-200 seemed to resolve metabolic acidosis and lactatemia more rapidly than HES, but not WB; yet it is not superior to HES in improving DO2I and DO2Im. The hyperoncotic property of solutions like Hb-200 that results in rapid volume expansion with more homogenous microvascular perfusion and the ability to facilitate diffusive O2 transfer accelerating metabolic recovery may be the key mechanisms underlying their beneficial effects as resuscitants.

  • does metHemoglobin from oxidized Hemoglobin based oxygen carrier Hemoglobin Glutamer 200 interfere with lactate measurement ysi 2700 select biochemistry analyzer
    Anesthesia & Analgesia, 2005
    Co-Authors: Stephen Osgood, Jonathan S. Jahr, Poonam Desai, Jessica Tsukamoto, Bernd Driessen
    Abstract:

    In this study, we validated the accuracy of lactate measurements (YSI 2700 SELECT glucose/lactate analyzer) in the presence of metHemoglobin from an oxidized bag of Hemoglobin-based oxygen carrier (Met-HBOC), Hemoglobin Glutamer-200 (Oxyglobin®; Biopure Corp). Different combinations of concentrated L-lactate solution, pooled canine plasma, and Plasmalyte A were added to 4 sample groups (1%, 10%, 20%, and 40% Met-HBOC [1.3 g/dL]) to yield linear increases in lactate concentration in consecutive samples. The mean difference between measured and calculated lactate was -5.1 mg/dL (1% Met-HBOC), -5.8 mg/dL (10% Met-HBOC), -4.6 mg (20% Met-HBOC), and -8.5 mg/dL (40% Met-HBOC). The root mean square error was 6.5 mg/dL, 7.4 mg/dL, 6.8 mg/dL, and 10.3 mg/dL, respectively. The Bland-Altman correlation (r) was r = -0.94 (P = 0.01), r = -0.91 (P < 0.001), r = -0.90 (P < 0.001), and r = -0.94 (P < 0.001), respectively, where r = 0 for perfect agreement between measured and calculated values. Results indicate that true lactate levels in the presence of Met-HBOC are underestimated when measured by an YSI 2700 analyzer independent of the amount of Met-HBOC present. When interpreting lactate concentrations from a patient with a HBOC present in plasma, underestimation of true lactate levels may occur unrelated to metHemoglobin concentrations.

  • blood substitute resuscitation as a treatment modality for moderate hypovolemia
    Artificial Cells Blood Substitutes and Biotechnology, 2004
    Co-Authors: Anthony T W Cheung, Jonathan S. Jahr, Bernd Driessen, Patricia L Duong, Sahana Ramanujam, Peter C Chen, Robert A Gunther
    Abstract:

    Blood substitute resuscitation as a treatment modality for moderate hypovolemia (˜40% blood loss) in a canine model has been evaluated using Oxyglobin® (Biopure Hemoglobin Glutamer-200/Bovine; a Hemoglobin-based oxygen-carrier) and Hespan® (6% hetastarch; a nonoxygen-carrier) as resuscitants. Autologous (shed) blood served as control. Nine dogs were studied—after splenectomy, each dog was hemorrhaged (32–36 mL/kg; MAP = ˜50 mmHg) and randomly assigned to the three resuscitation groups. Microvascular, systemic function and oxygenation characteristics were monitored and/or measured simultaneously in prehemorrhagic (baseline), posthemorrhagic and postresuscitation phases for correlation—real-time microvascular changes in the bulbar conjunctiva were noninvasively measured via computer-assisted intravital microscopy and systemic function and oxygenation changes were monitored and/or measured via instrumentation and devices incorporated into our bioengineering station in an operating room setting. Blood chemist...

  • arterial oxygenation and oxygen delivery after Hemoglobin based oxygen carrier infusion in canine hypovolemic shock a dose response study
    Critical Care Medicine, 2003
    Co-Authors: Bernd Driessen, Jonathan S. Jahr, Fedor Lurie, Mohammad S Golkaryeh, Robert A Gunther
    Abstract:

    OBJECTIVE: To compare effects of 6% hetastarch (Hextend) and Hemoglobin-based oxygen carrier Hemoglobin Glutamer-200 (Hb-200) (bovine; Oxyglobin) on hemodynamics, arterial oxygen content, and systemic oxygen delivery in a canine hemorrhagic shock model. DESIGN: Randomized laboratory investigation. SETTING: University surgical research facility. SUBJECTS: Twenty-four anesthetized healthy, adult, mongrel dogs (28 +/- 1 kg; 7 female, 17 male). INTERVENTIONS: Dogs were instrumented for determinations of heart rate, arterial, central venous, pulmonary arterial, and pulmonary arterial occlusion pressures, and cardiac index. Total solids, colloid oncotic pressure, arterial oxygen content, Hb, lactate, pH, and blood gases were analyzed in blood samples. Recordings were made before, after 1 hr of hemorrhagic shock, and immediately and 3 hrs after infusion of either 30 mL/kg hetastarch (group 1), 10 mL/kg Hb-200 + 20 mL/kg hetastarch (group 2), 20 mL/kg Hb-200 + 10 mL/kg hetastarch (group 3), or 30 mL/kg Hb-200 (group 4). MEASUREMENTS AND MAIN RESULTS: Hemorrhage (35 +/- 1 mL/kg) reduced mean arterial pressure to 50 mm Hg and caused significant decreases in total Hb, mean pulmonary arterial pressure, cardiac index and systemic oxygen delivery, increases in heart rate and systemic vascular resistance, and lactic acidosis. In group 1, hetastarch infusion was accompanied by increases of pulmonary arterial pressure, cardiac index, and blood oxygen extraction above baseline, and decreases of systemic vascular resistance, total Hb, total solids, arterial oxygen content, and systemic oxygen delivery below baseline (p <.05). Other data returned to baseline. In groups 2 to 4, hemodynamic functions (except pulmonary arterial pressure) recovered, yet neither total Hb (i.e., plasma and red blood cell Hb) nor arterial oxygen content increased despite increases in plasma Hb of 2 to 5 g/dL and proportionate increases in total solids. Systemic oxygen delivery improved dose-dependently with Hb-200 but did not return to baseline (p <.05), reaching values comparable to hetastarch group only at 30 mL/kg Hb-200. In all groups, oxygen extraction remained above baseline. Metabolic acidosis and lactatemia resolved significantly faster in groups 2 to 4, and colloid oncotic pressure after resuscitation was greater in groups 2 to 4 than in controls (p <.05). CONCLUSIONS: In hemorrhagic shock, Hb-200 infusion may not improve oxygen delivery more than hetastarch, likely due to hemodilution caused by its high colloid oncotic pressure, but may facilitate diffusive oxygen transport to tissues.

Jonathan S. Jahr - One of the best experts on this subject based on the ideXlab platform.

  • Does OxyVita, a new-generation Hemoglobin-based oxygen carrier, or oxyglobin acutely interfere with coagulation compared with normal saline or 6% hetastarch? An ex vivo thromboelastography study.
    Journal of Cardiothoracic and Vascular Anesthesia, 2008
    Co-Authors: Jonathan S. Jahr, David L. Weeks, Jennifer C. Lim, Anthony W. Butch, Robert A Gunther, Poonam Desai, Bernd Driessen
    Abstract:

    Objectives: Because hetastarches have deleterious effects on coagulation that increase with molecular weight (MWt), risk of coagulopathy associated with a high MWt Hemoglobin-based oxygen carrier (HBOC) was studied. Design: Preliminary laboratory study of donor blood using thromboelastography (TEG). Setting: University laboratory. Participants: Volunteer donor blood. Interventions: Experiments simulated hemodilution during clinical resuscitation of hemorrhagic shock with varying doses of HBOCs. Coagulopathy related to 1:11, 1:5, 1:2, or 1:1 dilution of whole blood with normal saline, 6% hetastarch (670 kilodaltons [kD]), Hemoglobin Glutamer-200 (HBOC-200, 200 kD), or OxyVita (OXYVITA Inc, New Windsor, NY) (a new-generation, zero-link polymerized bovine Hemoglobin-based oxygen carrier, 33 megadaltons) were analyzed. Measurements and Main Results: At 2 lower levels of hemodilution, hetastarch, HBOC-200, and OxyVita produced equivalent reductions in maximum clot strength (TEG-MA and TEG-G) that reached statistical significance compared with whole blood and normal saline. At 2 higher dilutions, OxyVita and HBOC-200 impaired maximum clot strength compared with whole blood, normal saline, and hetastarch. Dilution with hetastarch had a greater effect on clot propagation (K and α) than either HBOC. Conclusions: OxyVita and HBOC-200, HBOCs with different MWt, had similar effects on coagulation as measured by TEG. The impairment of coagulation by HBOCs and hetastarch occurred at doses corresponding to 12 mL/kg or a blood volume replacement of 17%. The use of HBOCs at doses corresponding to 23 mL/kg or a blood volume replacement of 33% significantly decreased coagulation to levels associated with increased clinical bleeding in this preliminary study. Minimal coagulopathic effects are expected with use of OxyVita at the manufacturer’s anticipated effective dose of 10 g or 2 to 3 mL/kg.

  • effects of isovolemic resuscitation with Hemoglobin based oxygen carrier Hemoglobin Glutamer 200 bovine on systemic and mesenteric perfusion and oxygenation in a canine model of hemorrhagic shock a comparison with 6 hetastarch solution and shed blood
    Veterinary Anaesthesia and Analgesia, 2006
    Co-Authors: Jonathan S. Jahr, Bernd Driessen, Fedor Lurie, R A Gunther
    Abstract:

    Objective To study Hemoglobin Glutamer-200 bovine (Hb-200), 6% hetastarch (HES) and shed whole blood (WB) resuscitation in canine hemorrhagic shock. Study design Prospective laboratory investigation. Animals Twelve adult dogs [29 ± 1 kg (mean ± SD)]. Methods Anesthetized dogs were instrumented for recording systemic and mesenteric hemodynamic parameters and withdrawal of arterial, mixed and mesenteric venous blood, in which hematological, oxygenation, blood gas and acid–bases variables were determined. Recordings were made before [baseline (BL)], after 1 hour of hypovolemia and immediately and 3 hours post-resuscitation with 30 mL kg−1 of either Hb-200, HES, or WB. Results Blood withdrawal (average 34 ± 2 mL kg−1) caused significant hemodynamic changes, metabolic acidosis and hyperlactatemia characteristic for hemorrhagic shock. Only WB transfusion restored all variables. Hemoglobin Glutamer-200 bovine infusion returned most hemodynamic parameters including cardiac output and mesenteric arterial blood flow to BL but increased mean arterial pressure above BL (p < 0.05). However, Hb-200 failed to restore total Hb and arterial oxygen content (CaO2), leaving systemic (DO2I) and mesenteric O2 delivery (DO2Im) below BL (p < 0.05). Nevertheless, acid–base variables recovered completely after Hb-200 resuscitation, and met-Hemoglobin (Met-Hb) levels increased (p < 0.05). Hetastarch resuscitation returned hemodynamic variables to or above BL but further decreased total Hb and CaO2, preventing recovery of sDO2I and mDO2I (p < 0.05). Thus, systemic and mesenteric O2 extraction stayed above BL (p < 0.05) while acid–base variables recovered to BL, although slower than in Hb-200 and WB groups (p < 0.05). Conclusions and clinical relevance Resuscitation with Hb-200 seemed to resolve metabolic acidosis and lactatemia more rapidly than HES, but not WB; yet it is not superior to HES in improving DO2I and DO2Im. The hyperoncotic property of solutions like Hb-200 that results in rapid volume expansion with more homogenous microvascular perfusion and the ability to facilitate diffusive O2 transfer accelerating metabolic recovery may be the key mechanisms underlying their beneficial effects as resuscitants.

  • does metHemoglobin from oxidized Hemoglobin based oxygen carrier Hemoglobin Glutamer 200 interfere with lactate measurement ysi 2700 select biochemistry analyzer
    Anesthesia & Analgesia, 2005
    Co-Authors: Stephen Osgood, Jonathan S. Jahr, Poonam Desai, Jessica Tsukamoto, Bernd Driessen
    Abstract:

    In this study, we validated the accuracy of lactate measurements (YSI 2700 SELECT glucose/lactate analyzer) in the presence of metHemoglobin from an oxidized bag of Hemoglobin-based oxygen carrier (Met-HBOC), Hemoglobin Glutamer-200 (Oxyglobin®; Biopure Corp). Different combinations of concentrated L-lactate solution, pooled canine plasma, and Plasmalyte A were added to 4 sample groups (1%, 10%, 20%, and 40% Met-HBOC [1.3 g/dL]) to yield linear increases in lactate concentration in consecutive samples. The mean difference between measured and calculated lactate was -5.1 mg/dL (1% Met-HBOC), -5.8 mg/dL (10% Met-HBOC), -4.6 mg (20% Met-HBOC), and -8.5 mg/dL (40% Met-HBOC). The root mean square error was 6.5 mg/dL, 7.4 mg/dL, 6.8 mg/dL, and 10.3 mg/dL, respectively. The Bland-Altman correlation (r) was r = -0.94 (P = 0.01), r = -0.91 (P < 0.001), r = -0.90 (P < 0.001), and r = -0.94 (P < 0.001), respectively, where r = 0 for perfect agreement between measured and calculated values. Results indicate that true lactate levels in the presence of Met-HBOC are underestimated when measured by an YSI 2700 analyzer independent of the amount of Met-HBOC present. When interpreting lactate concentrations from a patient with a HBOC present in plasma, underestimation of true lactate levels may occur unrelated to metHemoglobin concentrations.

  • blood substitute resuscitation as a treatment modality for moderate hypovolemia
    Artificial Cells Blood Substitutes and Biotechnology, 2004
    Co-Authors: Anthony T W Cheung, Jonathan S. Jahr, Bernd Driessen, Patricia L Duong, Sahana Ramanujam, Peter C Chen, Robert A Gunther
    Abstract:

    Blood substitute resuscitation as a treatment modality for moderate hypovolemia (˜40% blood loss) in a canine model has been evaluated using Oxyglobin® (Biopure Hemoglobin Glutamer-200/Bovine; a Hemoglobin-based oxygen-carrier) and Hespan® (6% hetastarch; a nonoxygen-carrier) as resuscitants. Autologous (shed) blood served as control. Nine dogs were studied—after splenectomy, each dog was hemorrhaged (32–36 mL/kg; MAP = ˜50 mmHg) and randomly assigned to the three resuscitation groups. Microvascular, systemic function and oxygenation characteristics were monitored and/or measured simultaneously in prehemorrhagic (baseline), posthemorrhagic and postresuscitation phases for correlation—real-time microvascular changes in the bulbar conjunctiva were noninvasively measured via computer-assisted intravital microscopy and systemic function and oxygenation changes were monitored and/or measured via instrumentation and devices incorporated into our bioengineering station in an operating room setting. Blood chemist...

  • arterial oxygenation and oxygen delivery after Hemoglobin based oxygen carrier infusion in canine hypovolemic shock a dose response study
    Critical Care Medicine, 2003
    Co-Authors: Bernd Driessen, Jonathan S. Jahr, Fedor Lurie, Mohammad S Golkaryeh, Robert A Gunther
    Abstract:

    OBJECTIVE: To compare effects of 6% hetastarch (Hextend) and Hemoglobin-based oxygen carrier Hemoglobin Glutamer-200 (Hb-200) (bovine; Oxyglobin) on hemodynamics, arterial oxygen content, and systemic oxygen delivery in a canine hemorrhagic shock model. DESIGN: Randomized laboratory investigation. SETTING: University surgical research facility. SUBJECTS: Twenty-four anesthetized healthy, adult, mongrel dogs (28 +/- 1 kg; 7 female, 17 male). INTERVENTIONS: Dogs were instrumented for determinations of heart rate, arterial, central venous, pulmonary arterial, and pulmonary arterial occlusion pressures, and cardiac index. Total solids, colloid oncotic pressure, arterial oxygen content, Hb, lactate, pH, and blood gases were analyzed in blood samples. Recordings were made before, after 1 hr of hemorrhagic shock, and immediately and 3 hrs after infusion of either 30 mL/kg hetastarch (group 1), 10 mL/kg Hb-200 + 20 mL/kg hetastarch (group 2), 20 mL/kg Hb-200 + 10 mL/kg hetastarch (group 3), or 30 mL/kg Hb-200 (group 4). MEASUREMENTS AND MAIN RESULTS: Hemorrhage (35 +/- 1 mL/kg) reduced mean arterial pressure to 50 mm Hg and caused significant decreases in total Hb, mean pulmonary arterial pressure, cardiac index and systemic oxygen delivery, increases in heart rate and systemic vascular resistance, and lactic acidosis. In group 1, hetastarch infusion was accompanied by increases of pulmonary arterial pressure, cardiac index, and blood oxygen extraction above baseline, and decreases of systemic vascular resistance, total Hb, total solids, arterial oxygen content, and systemic oxygen delivery below baseline (p <.05). Other data returned to baseline. In groups 2 to 4, hemodynamic functions (except pulmonary arterial pressure) recovered, yet neither total Hb (i.e., plasma and red blood cell Hb) nor arterial oxygen content increased despite increases in plasma Hb of 2 to 5 g/dL and proportionate increases in total solids. Systemic oxygen delivery improved dose-dependently with Hb-200 but did not return to baseline (p <.05), reaching values comparable to hetastarch group only at 30 mL/kg Hb-200. In all groups, oxygen extraction remained above baseline. Metabolic acidosis and lactatemia resolved significantly faster in groups 2 to 4, and colloid oncotic pressure after resuscitation was greater in groups 2 to 4 than in controls (p <.05). CONCLUSIONS: In hemorrhagic shock, Hb-200 infusion may not improve oxygen delivery more than hetastarch, likely due to hemodilution caused by its high colloid oncotic pressure, but may facilitate diffusive oxygen transport to tissues.

Fedor Lurie - One of the best experts on this subject based on the ideXlab platform.

  • effects of isovolemic resuscitation with Hemoglobin based oxygen carrier Hemoglobin Glutamer 200 bovine on systemic and mesenteric perfusion and oxygenation in a canine model of hemorrhagic shock a comparison with 6 hetastarch solution and shed blood
    Veterinary Anaesthesia and Analgesia, 2006
    Co-Authors: Jonathan S. Jahr, Bernd Driessen, Fedor Lurie, R A Gunther
    Abstract:

    Objective To study Hemoglobin Glutamer-200 bovine (Hb-200), 6% hetastarch (HES) and shed whole blood (WB) resuscitation in canine hemorrhagic shock. Study design Prospective laboratory investigation. Animals Twelve adult dogs [29 ± 1 kg (mean ± SD)]. Methods Anesthetized dogs were instrumented for recording systemic and mesenteric hemodynamic parameters and withdrawal of arterial, mixed and mesenteric venous blood, in which hematological, oxygenation, blood gas and acid–bases variables were determined. Recordings were made before [baseline (BL)], after 1 hour of hypovolemia and immediately and 3 hours post-resuscitation with 30 mL kg−1 of either Hb-200, HES, or WB. Results Blood withdrawal (average 34 ± 2 mL kg−1) caused significant hemodynamic changes, metabolic acidosis and hyperlactatemia characteristic for hemorrhagic shock. Only WB transfusion restored all variables. Hemoglobin Glutamer-200 bovine infusion returned most hemodynamic parameters including cardiac output and mesenteric arterial blood flow to BL but increased mean arterial pressure above BL (p < 0.05). However, Hb-200 failed to restore total Hb and arterial oxygen content (CaO2), leaving systemic (DO2I) and mesenteric O2 delivery (DO2Im) below BL (p < 0.05). Nevertheless, acid–base variables recovered completely after Hb-200 resuscitation, and met-Hemoglobin (Met-Hb) levels increased (p < 0.05). Hetastarch resuscitation returned hemodynamic variables to or above BL but further decreased total Hb and CaO2, preventing recovery of sDO2I and mDO2I (p < 0.05). Thus, systemic and mesenteric O2 extraction stayed above BL (p < 0.05) while acid–base variables recovered to BL, although slower than in Hb-200 and WB groups (p < 0.05). Conclusions and clinical relevance Resuscitation with Hb-200 seemed to resolve metabolic acidosis and lactatemia more rapidly than HES, but not WB; yet it is not superior to HES in improving DO2I and DO2Im. The hyperoncotic property of solutions like Hb-200 that results in rapid volume expansion with more homogenous microvascular perfusion and the ability to facilitate diffusive O2 transfer accelerating metabolic recovery may be the key mechanisms underlying their beneficial effects as resuscitants.

  • arterial oxygenation and oxygen delivery after Hemoglobin based oxygen carrier infusion in canine hypovolemic shock a dose response study
    Critical Care Medicine, 2003
    Co-Authors: Bernd Driessen, Jonathan S. Jahr, Fedor Lurie, Mohammad S Golkaryeh, Robert A Gunther
    Abstract:

    OBJECTIVE: To compare effects of 6% hetastarch (Hextend) and Hemoglobin-based oxygen carrier Hemoglobin Glutamer-200 (Hb-200) (bovine; Oxyglobin) on hemodynamics, arterial oxygen content, and systemic oxygen delivery in a canine hemorrhagic shock model. DESIGN: Randomized laboratory investigation. SETTING: University surgical research facility. SUBJECTS: Twenty-four anesthetized healthy, adult, mongrel dogs (28 +/- 1 kg; 7 female, 17 male). INTERVENTIONS: Dogs were instrumented for determinations of heart rate, arterial, central venous, pulmonary arterial, and pulmonary arterial occlusion pressures, and cardiac index. Total solids, colloid oncotic pressure, arterial oxygen content, Hb, lactate, pH, and blood gases were analyzed in blood samples. Recordings were made before, after 1 hr of hemorrhagic shock, and immediately and 3 hrs after infusion of either 30 mL/kg hetastarch (group 1), 10 mL/kg Hb-200 + 20 mL/kg hetastarch (group 2), 20 mL/kg Hb-200 + 10 mL/kg hetastarch (group 3), or 30 mL/kg Hb-200 (group 4). MEASUREMENTS AND MAIN RESULTS: Hemorrhage (35 +/- 1 mL/kg) reduced mean arterial pressure to 50 mm Hg and caused significant decreases in total Hb, mean pulmonary arterial pressure, cardiac index and systemic oxygen delivery, increases in heart rate and systemic vascular resistance, and lactic acidosis. In group 1, hetastarch infusion was accompanied by increases of pulmonary arterial pressure, cardiac index, and blood oxygen extraction above baseline, and decreases of systemic vascular resistance, total Hb, total solids, arterial oxygen content, and systemic oxygen delivery below baseline (p <.05). Other data returned to baseline. In groups 2 to 4, hemodynamic functions (except pulmonary arterial pressure) recovered, yet neither total Hb (i.e., plasma and red blood cell Hb) nor arterial oxygen content increased despite increases in plasma Hb of 2 to 5 g/dL and proportionate increases in total solids. Systemic oxygen delivery improved dose-dependently with Hb-200 but did not return to baseline (p <.05), reaching values comparable to hetastarch group only at 30 mL/kg Hb-200. In all groups, oxygen extraction remained above baseline. Metabolic acidosis and lactatemia resolved significantly faster in groups 2 to 4, and colloid oncotic pressure after resuscitation was greater in groups 2 to 4 than in controls (p <.05). CONCLUSIONS: In hemorrhagic shock, Hb-200 infusion may not improve oxygen delivery more than hetastarch, likely due to hemodilution caused by its high colloid oncotic pressure, but may facilitate diffusive oxygen transport to tissues.

  • the novel hemocue plasma low Hemoglobin system accurately measures small concentrations of three different Hemoglobin based oxygen carriers in plasma Hemoglobin Glutamer 200 bovine oxyglobin Hemoglobin Glutamer 250 bovine hemopure and Hemoglobin raffimer hemolink
    Anesthesia & Analgesia, 2002
    Co-Authors: Fedor Lurie, Jonathan S. Jahr, Bernd Driessen
    Abstract:

    UNLABELLED: The accuracy of the HemoCue Plasma/Low Hemoglobin System was validated in vitr. with low levels of Hemoglobin-based oxygen carriers (HBOCs). Repeated measurements were performed on 50 samples of canine plasma, each mixed with three different HBOCs at varying small concentrations (a total of 150 samples), by using plasma samples without HBOCs as controls. Two technicians performed the measurements and randomly tested each sample 10 times. The results were analyzed for correlation, and analysis of variance was used to evaluate statistical significance, with a P value of Hemoglobin concentrations determined with the bedside photometer were not significantly different from known values of Hemoglobin concentration in the samples. There was no significant difference between values obtained by two independent observers for the same samples. This was true for all three tested HBOCs and for all tested concentrations. The mean bias of the measurement expressed as a percentage of sample concentration was 0.1% for Hemoglobin Glutamer-200 (bovine), 0.58% for Hemoglobin Glutamer-250 (bovine), and 0.19% for Hemoglobin-raffimer. The mean error was <8% for all three HBOCs. Both intraobserver and interobserver reliabilities were high and statistically significant. The HemoCue Plasma/Low Hemoglobin System is a reliable instrument for detecting and measuring small concentrations of three different HBOCs in plasma. IMPLICATIONS: This study evaluated a new bedside blood-measuring device for low levels and found that it rapidly measured low levels accurately for three blood substitutes.

Robert A Gunther - One of the best experts on this subject based on the ideXlab platform.

  • Does OxyVita, a new-generation Hemoglobin-based oxygen carrier, or oxyglobin acutely interfere with coagulation compared with normal saline or 6% hetastarch? An ex vivo thromboelastography study.
    Journal of Cardiothoracic and Vascular Anesthesia, 2008
    Co-Authors: Jonathan S. Jahr, David L. Weeks, Jennifer C. Lim, Anthony W. Butch, Robert A Gunther, Poonam Desai, Bernd Driessen
    Abstract:

    Objectives: Because hetastarches have deleterious effects on coagulation that increase with molecular weight (MWt), risk of coagulopathy associated with a high MWt Hemoglobin-based oxygen carrier (HBOC) was studied. Design: Preliminary laboratory study of donor blood using thromboelastography (TEG). Setting: University laboratory. Participants: Volunteer donor blood. Interventions: Experiments simulated hemodilution during clinical resuscitation of hemorrhagic shock with varying doses of HBOCs. Coagulopathy related to 1:11, 1:5, 1:2, or 1:1 dilution of whole blood with normal saline, 6% hetastarch (670 kilodaltons [kD]), Hemoglobin Glutamer-200 (HBOC-200, 200 kD), or OxyVita (OXYVITA Inc, New Windsor, NY) (a new-generation, zero-link polymerized bovine Hemoglobin-based oxygen carrier, 33 megadaltons) were analyzed. Measurements and Main Results: At 2 lower levels of hemodilution, hetastarch, HBOC-200, and OxyVita produced equivalent reductions in maximum clot strength (TEG-MA and TEG-G) that reached statistical significance compared with whole blood and normal saline. At 2 higher dilutions, OxyVita and HBOC-200 impaired maximum clot strength compared with whole blood, normal saline, and hetastarch. Dilution with hetastarch had a greater effect on clot propagation (K and α) than either HBOC. Conclusions: OxyVita and HBOC-200, HBOCs with different MWt, had similar effects on coagulation as measured by TEG. The impairment of coagulation by HBOCs and hetastarch occurred at doses corresponding to 12 mL/kg or a blood volume replacement of 17%. The use of HBOCs at doses corresponding to 23 mL/kg or a blood volume replacement of 33% significantly decreased coagulation to levels associated with increased clinical bleeding in this preliminary study. Minimal coagulopathic effects are expected with use of OxyVita at the manufacturer’s anticipated effective dose of 10 g or 2 to 3 mL/kg.

  • blood substitute resuscitation as a treatment modality for moderate hypovolemia
    Artificial Cells Blood Substitutes and Biotechnology, 2004
    Co-Authors: Anthony T W Cheung, Jonathan S. Jahr, Bernd Driessen, Patricia L Duong, Sahana Ramanujam, Peter C Chen, Robert A Gunther
    Abstract:

    Blood substitute resuscitation as a treatment modality for moderate hypovolemia (˜40% blood loss) in a canine model has been evaluated using Oxyglobin® (Biopure Hemoglobin Glutamer-200/Bovine; a Hemoglobin-based oxygen-carrier) and Hespan® (6% hetastarch; a nonoxygen-carrier) as resuscitants. Autologous (shed) blood served as control. Nine dogs were studied—after splenectomy, each dog was hemorrhaged (32–36 mL/kg; MAP = ˜50 mmHg) and randomly assigned to the three resuscitation groups. Microvascular, systemic function and oxygenation characteristics were monitored and/or measured simultaneously in prehemorrhagic (baseline), posthemorrhagic and postresuscitation phases for correlation—real-time microvascular changes in the bulbar conjunctiva were noninvasively measured via computer-assisted intravital microscopy and systemic function and oxygenation changes were monitored and/or measured via instrumentation and devices incorporated into our bioengineering station in an operating room setting. Blood chemist...

  • arterial oxygenation and oxygen delivery after Hemoglobin based oxygen carrier infusion in canine hypovolemic shock a dose response study
    Critical Care Medicine, 2003
    Co-Authors: Bernd Driessen, Jonathan S. Jahr, Fedor Lurie, Mohammad S Golkaryeh, Robert A Gunther
    Abstract:

    OBJECTIVE: To compare effects of 6% hetastarch (Hextend) and Hemoglobin-based oxygen carrier Hemoglobin Glutamer-200 (Hb-200) (bovine; Oxyglobin) on hemodynamics, arterial oxygen content, and systemic oxygen delivery in a canine hemorrhagic shock model. DESIGN: Randomized laboratory investigation. SETTING: University surgical research facility. SUBJECTS: Twenty-four anesthetized healthy, adult, mongrel dogs (28 +/- 1 kg; 7 female, 17 male). INTERVENTIONS: Dogs were instrumented for determinations of heart rate, arterial, central venous, pulmonary arterial, and pulmonary arterial occlusion pressures, and cardiac index. Total solids, colloid oncotic pressure, arterial oxygen content, Hb, lactate, pH, and blood gases were analyzed in blood samples. Recordings were made before, after 1 hr of hemorrhagic shock, and immediately and 3 hrs after infusion of either 30 mL/kg hetastarch (group 1), 10 mL/kg Hb-200 + 20 mL/kg hetastarch (group 2), 20 mL/kg Hb-200 + 10 mL/kg hetastarch (group 3), or 30 mL/kg Hb-200 (group 4). MEASUREMENTS AND MAIN RESULTS: Hemorrhage (35 +/- 1 mL/kg) reduced mean arterial pressure to 50 mm Hg and caused significant decreases in total Hb, mean pulmonary arterial pressure, cardiac index and systemic oxygen delivery, increases in heart rate and systemic vascular resistance, and lactic acidosis. In group 1, hetastarch infusion was accompanied by increases of pulmonary arterial pressure, cardiac index, and blood oxygen extraction above baseline, and decreases of systemic vascular resistance, total Hb, total solids, arterial oxygen content, and systemic oxygen delivery below baseline (p <.05). Other data returned to baseline. In groups 2 to 4, hemodynamic functions (except pulmonary arterial pressure) recovered, yet neither total Hb (i.e., plasma and red blood cell Hb) nor arterial oxygen content increased despite increases in plasma Hb of 2 to 5 g/dL and proportionate increases in total solids. Systemic oxygen delivery improved dose-dependently with Hb-200 but did not return to baseline (p <.05), reaching values comparable to hetastarch group only at 30 mL/kg Hb-200. In all groups, oxygen extraction remained above baseline. Metabolic acidosis and lactatemia resolved significantly faster in groups 2 to 4, and colloid oncotic pressure after resuscitation was greater in groups 2 to 4 than in controls (p <.05). CONCLUSIONS: In hemorrhagic shock, Hb-200 infusion may not improve oxygen delivery more than hetastarch, likely due to hemodilution caused by its high colloid oncotic pressure, but may facilitate diffusive oxygen transport to tissues.

R A Gunther - One of the best experts on this subject based on the ideXlab platform.

  • effects of isovolemic resuscitation with Hemoglobin based oxygen carrier Hemoglobin Glutamer 200 bovine on systemic and mesenteric perfusion and oxygenation in a canine model of hemorrhagic shock a comparison with 6 hetastarch solution and shed blood
    Veterinary Anaesthesia and Analgesia, 2006
    Co-Authors: Jonathan S. Jahr, Bernd Driessen, Fedor Lurie, R A Gunther
    Abstract:

    Objective To study Hemoglobin Glutamer-200 bovine (Hb-200), 6% hetastarch (HES) and shed whole blood (WB) resuscitation in canine hemorrhagic shock. Study design Prospective laboratory investigation. Animals Twelve adult dogs [29 ± 1 kg (mean ± SD)]. Methods Anesthetized dogs were instrumented for recording systemic and mesenteric hemodynamic parameters and withdrawal of arterial, mixed and mesenteric venous blood, in which hematological, oxygenation, blood gas and acid–bases variables were determined. Recordings were made before [baseline (BL)], after 1 hour of hypovolemia and immediately and 3 hours post-resuscitation with 30 mL kg−1 of either Hb-200, HES, or WB. Results Blood withdrawal (average 34 ± 2 mL kg−1) caused significant hemodynamic changes, metabolic acidosis and hyperlactatemia characteristic for hemorrhagic shock. Only WB transfusion restored all variables. Hemoglobin Glutamer-200 bovine infusion returned most hemodynamic parameters including cardiac output and mesenteric arterial blood flow to BL but increased mean arterial pressure above BL (p < 0.05). However, Hb-200 failed to restore total Hb and arterial oxygen content (CaO2), leaving systemic (DO2I) and mesenteric O2 delivery (DO2Im) below BL (p < 0.05). Nevertheless, acid–base variables recovered completely after Hb-200 resuscitation, and met-Hemoglobin (Met-Hb) levels increased (p < 0.05). Hetastarch resuscitation returned hemodynamic variables to or above BL but further decreased total Hb and CaO2, preventing recovery of sDO2I and mDO2I (p < 0.05). Thus, systemic and mesenteric O2 extraction stayed above BL (p < 0.05) while acid–base variables recovered to BL, although slower than in Hb-200 and WB groups (p < 0.05). Conclusions and clinical relevance Resuscitation with Hb-200 seemed to resolve metabolic acidosis and lactatemia more rapidly than HES, but not WB; yet it is not superior to HES in improving DO2I and DO2Im. The hyperoncotic property of solutions like Hb-200 that results in rapid volume expansion with more homogenous microvascular perfusion and the ability to facilitate diffusive O2 transfer accelerating metabolic recovery may be the key mechanisms underlying their beneficial effects as resuscitants.