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      Hemodilución normovolémica inducida: mejoría de los valores hemodinámicos y gasométricos en pacientes con claudicación a la marcha Translated title: Induced normovolemic hemodilution: improvement of the hemodynamic and gasometric values in patients with walk claudication

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          Abstract

          Se realizó un estudio de casos y controles de 49 pacientes con claudicación intermitente a la marcha, atendidos en la consulta de hemodilución del Hospital Provincial Docente "Dr. Joaquín Castillo Duany" de Santiago de Cuba en un quinquenio, a fin de identificar los cambios observados en la hiperemia y gasometría de la población investigada. Los integrantes de la casuística fueron asignados a uno de 2 grupos: los tratados con hemodilución normovolémica inducida (grupo de estudio) y los que recibieron tratamiento convencional con vasodilatadores antiagregantes y ejercicio físico (grupo control), teniendo en cuenta la presencia de factores de riesgo en ambos. Se concluyó que los primeros mejoraron las condiciones hemodinámicas y de oxigenación, dadas por el aumento del índice de amplitud y de la relación consumo de oxígeno e índice de flujo eritrocitario.

          Translated abstract

          A case-control study of 49 patients with intermittent walk claudication, assisted at the hemodilution service of "Dr. Joaquín Castillo Duany" Teaching Provincial Hospital in Santiago de Cuba was carried out in a five year period, in order to identify the changes observed in the hyperemia and gasometry of the investigated population. The case material was assigned to one of 2 groups: the patients treated with induced normovolemic hemodilution (study group), and those who received conventional treatment with antiplatelet vasodilators and physical exercise (control group), keeping in mind the presence of risk factors for both. It was concluded that the first ones improved hemodynamics and oxygenation conditions, given by the increase of the width index and of the relationship between oxygen consumption and erythocytes flow index.

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          Most cited references14

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          Effects of erythrocyte flexibility on microvascular perfusion and oxygenation during acute anemia.

          Responses to exchange transfusion using red blood cells (RBCs) with normal and reduced flexibility were studied in the hamster window chamber model during acute moderate isovolemic hemodilution to determine the role of RBC membrane stiffness in microvascular perfusion and tissue oxygenation. Erythrocyte stiffness was increased by 30-min incubation in 0.02% glutaraldehyde solution, and unreacted glutaraldehyde was completely removed. Filtration pressure through 5-microm pore size filters was used to quantify stiffness of the RBCs. Anemic conditions were induced by two isovolemic hemodilution steps using 6% 70-kDa dextran to a hematocrit (Hct) of 18% (moderate hemodilution). The protocol continued with an exchange transfusion to reduce native RBCs to 75% of baseline (11% Hct) with either fresh RBCs (RBC group) or reduced-flexibility RBCs (GRBC group) suspended in 5% albumin at 18% Hct; a plasma expander (6% 70-kDa dextran; Dex70 group) was used as control. Systemic parameters, microvascular perfusion, capillary perfusion [functional capillary density (FCD)], and oxygen levels across the microvascular network were measured by noninvasive methods. RBC deformability for GRBCs was significantly decreased compared with RBCs and moderate hemodilution conditions. The GRBC group had a greater mean arterial blood pressure (MAP) than the RBC and Dex70 groups. FCD was substantially higher for RBC (0.81 +/- 0.07 of baseline) vs. GRBC (0.32 +/- 0.10 of baseline) and Dex70 (0.38 +/- 0.10 of baseline) groups. Microvascular tissue Po(2) was significantly lower for Dex70 and GRBC vs. RBC groups and the moderate hemodilution condition. Results were attributed to decreased oxygen uploading in the lungs and obstruction of tissue capillaries by rigidified RBCs, indicating that the effects impairing RBC flexibility are magnified at the microvascular level, where perfusion and oxygenation may define transfusion outcome.
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            The association of hemodilution and transfusion of red blood cells with biochemical markers of splanchnic and renal injury during cardiopulmonary bypass.

            Hemodilution is the main cause of a low hematocrit concentration during cardiopulmonary bypass. This low hematocrit may be insufficient for optimal tissue oxygen delivery and often results in packed cell transfusion. Our objective in this study was to find a relationship between intraoperative hematocrit and allogeneic blood transfusion on release of postoperative injury markers from the kidneys and the splanchnic area. Fifty consecutive patients undergoing coronary artery bypass grafting with cardiopulmonary bypass were included. Systemic tissue hypoxia was assessed by lactate concentrations. Kidney and splanchnic ischemia were assessed by the measurement of N-acetyl-beta-D-glucosaminidase (NAG) and intestinal fatty acid binding protein (IFABP) in urine. Patients were retrospectively placed into groups according to their lowest hematocrit concentration on bypass ( or=24%). The intraoperative lactate and the postoperative NAG and IFABP concentrations were higher in the low hematocrit group ( or=24%; P < 0.05). Low hematocrit correlated with higher lactate concentrations (R(2) = 0.150, P < 0.01) and with higher NAG concentrations (R(2) = 0.138, P < 0.01) and IFABP concentrations (R(2) = 0.107, P < 0.01) postoperatively. Transfusion of packed cells during cardiopulmonary bypass correlated with higher lactate (R(2) = 0.089, P < 0.05), NAG (R(2) = 0.431, P < 0.01), and IFABP concentrations (R(2) = 0.189, P < 0.01). The results support the concept that hemodilution below an intraoperative hematocrit of 24% and consequently transfusion of red blood cells is related to release of injury markers of the kidneys and splanchnic area.
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              Oxygen release from arterioles with normal flow and no-flow conditions.

              The rate of oxygen release from arterioles ( approximately 55 microm diameter) was measured in the hamster window chamber model during flow and no-flow conditions. Flow was stopped by microvascular transcutaneous occlusion using a glass pipette held by a manipulator. The reduction of the intra-arteriolar oxygen tension (Po2) was measured by the phosphorescence quenching of preinfused Pd-porphyrin, 100 microm downstream from the occlusion. Oxygen release from arterioles was found to be 53% greater during flow than no-flow conditions (2.6 vs. 1.7 x 10(-5) ml O2.cm(-2).s(-1), P 15% of the total oxygen delivery to tissues by arterioles during flow in this preparation.
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                Author and article information

                Journal
                san
                MEDISAN
                MEDISAN
                Centro Provincial de Información de Ciencias Médicas (Santiago de Cuba, , Cuba )
                1029-3019
                June 2010
                : 14
                : 4
                Affiliations
                [01] Santiago de Cuba orgnameHospital Provincial Docente Dr. Joaquín Castillo Duany Cuba
                [02] Santiago de Cuba orgnameHospital Provincial Docente Dr. Ambrosio Grillo Portuondo Cuba
                Article
                S1029-30192010000400001 S1029-3019(10)01400401
                bdd83426-85a8-47d4-9bd6-0b8facf74525

                This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

                History
                : 12 December 2009
                : 26 November 2009
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 14, Pages: 0
                Product

                SciELO Cuba

                Categories
                ARTÍCULOS ORIGINALES

                hemogasometry,ejercicio físico,vasodilatadores antiagregantes,hemodinamia,hemogasometría,hiperemia reactiva,claudicación intermitente a la marcha,hemodilución normovolémica inducida,physical exercise,antiplatelet vasodilators,hemodinamics,induced normovolemic hemodilution,intermittent walk claudication,reactive hyperemia

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