• Arnaldo Dubin, Mario Omar Pozo, Gonzalo Ferrara, Gastón Murias, Enrique Martins, Carlos Canullán, Héctor Saul Canales, Vanina Siham Kanoore Edul, Elisa Estenssoro, and Can Ince.
• Facultad de Ciencias Médicas, Cátedra de Farmacología Aplicada, Universidad Nacional de La Plata, La Plata, Argentina. arnaldodubin@speedy.com.ar
• Intensive Care Med. 2009 Mar 1; 35 (3): 556-64.

ObjectiveTo compare systemic hemodynamics with microcirculatory changes at different vascular beds during progressive hemorrhage.SettingUniversity-based research laboratory.SubjectsTwelve anesthetized, mechanically ventilated sheep.InterventionsSheep were randomly assigned to HEMORRHAGE or CONTROL group. In the HEMORRHAGE group (n = 8), three stepwise bleedings of 5 ml/kg at 30-min intervals were performed to add up 15 ml/kg. In the CONTROL group (n = 4), sheep had the same surgical preparation but were not bled.Measurements And Main ResultsProgressive bleeding decreased cardiac output, and superior mesenteric artery blood flow, and systemic and intestinal oxygen transports from the first step of bleeding whereas systemic and intestinal oxygen consumption remained unchanged. Mean arterial blood pressure, arterial pH and base excess, and intramucosal-arterial PCO(2) were only significantly modified in the last step of bleeding. Arterial lactate increased and sublingual, and intestinal serosal and mucosal capillary microvascular flow indexes and red blood cell velocities progressively decreased after the first step of bleeding (3.0 +/- 0.1 vs. 2.3 +/- 0.4, 3.2 +/- 0.2 vs. 2.4 +/- 0.6, 3.0 +/- 0.0 vs. 2.0 +/- 0.2, and 1,082 +/- 29 vs. 977 +/- 79, 1,042 +/- 24 vs. 953 +/- 60, 287 +/- 65 vs. 262 +/- 16 mum/s; P < 0.05 for all).ConclusionsAlterations in sublingual, intestinal microcirculation, and arterial lactate simultaneously arose from the first step of bleeding. The microcirculatory changes were identified either by semi-quantitative flow index or by quantitative red blood cell velocity measurements.

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