Acute Blood Loss: Regional Blood Flow and Microcirculation (Review, Part I)
https://doi.org/10.15360/1813-9779-2016-2-66-89
Abstract
The first part of the review highlights the data on the structural and functional organization of the microvas culature; regulation of vascular tone including local (metabolic and myogenic mechanisms, role of endothelium and red blood cells) and systemic (nervous, humoral) factors; general issues of microcirculatory alterations in blood loss and shock. Acute blood loss is considered as a phasic development of compensatory and adaptive processes involving the blood system, cardiovascular, nervous and endocrine systems. Changes in oxygen transport, the pathogenesis of hypoxia and metabolic abnormalities in blood loss and hemorrhagic shock are described. Examples of the vicious circles contributing to acute blood loss pathogenesis are considered as a base for developing decompensated hemorrhagic shock in which the role of hemostasis and blood rheology alterations are also considered.
About the Authors
V. V. Moroz
V. A. Negovsky Research Institute of General Reanimatology
Russian Federation
25, Petrovka Str., Build. 2, Moscow 107031, Russia
Russian Federation
25, Petrovka Str., Build. 2, Moscow 107031, Russia
I. A. Ryzhkov
V. A. Negovsky Research Institute of General Reanimatology
Russian Federation
25, Petrovka Str., Build. 2, Moscow 107031, Russia
Russian Federation
25, Petrovka Str., Build. 2, Moscow 107031, Russia
References
1. Litvitsky P.F. Patofiziologiya. 4e izd. [Pathophysiology. 4th ed.]. Moscow: GEOTARMedia; 2010: 496. [In Russ.]
2. Dutton R.P. Current concepts in hemorrhagic shock. Anesthesiol. Clin. 2007; 25 (1): 23–34. http://dx.doi.org/10.1016/j.atc.2006.11.007. PMID: 17400153
3. Moroz V.V., Bobrinskaya I.G., Vasilyev V.Yu., Spiridonova E.A., Tishkov E.A., Suryakhin V.S. Shok. Uchebnometodicheskoe posobie dlya studentov, ordinatorov, aspirantov i vrachei. [Shock. Study guide for students, residents, graduate students and physicians]. Moscow; 2011: 29. [In Russ.]
4. Tokmakova T.O., Permyakova S.Yu., Kiseleva A.V., Shukevich D.L., Grigoryev E.V. Monitoring mikrotsirkulyatsii v kriticheskikh sostoyaniyakh: vozmozhnosti i ogranicheniya. Obshchaya Reanimatologiya. [Monitoring the microcirculation in critical conditions: possibilities and limitations. General Reanimatology]. 2012; 8 (2): 74–78. http://dx.doi.org/10.15360/181397792012274. [In Russ.]
5. Donati A., Domizi R., Damiani E., Adrario E., Pelaia P., Ince C. From macrohemodynamic to the microcirculation. Crit. Care Res. Pract. 2013; 2013: 892710. http://dx.doi.org/10.1155/2013/892710. PMID: 23509621
6. Kozlov V.I. Sistema mikrotsirkulyatsii krovi: klinikomorfologicheskie aspekty izucheniya. [The system of microcirculation: clinicalmorphological aspects of studying]. Regionarnoe Krovoobrashchenie i Mikrotsirkulyatsiya. 2006; 5 (1): 84–101. [In Russ.]
7. Krupatkin A.I., Sidorov V.V. Funktsionalnaya diagnostika sostoyaniya mikrotsirkulyatornotkanevykh system: kolebaniya, informatsiya, nelineinost. [Functional diagnosis of the state of microcirculatory tissue systems: fluctuations, information, nonlinearity]. Moscow: LIBROKOM; 2013: 496. [In Russ.]
8. Witzleb E. Funktsii sosudistoi sistemy. V kn.: Shmidt P., Tevs G. (red.). Fiziologiya cheloveka. [The functions of the vascular system. In: Shmidt P., Tevs G. (ed.). Human Physiology]. Moscow: Mir; 2004: 498–566. [In Russ.]
9. Morman D., Heller L. Fiziologiya serdechnososudistoi sistemy. [Physiology of the cardiovascular system]. SanktPeterburg: Piter; 2000: 256. [In Russ.]
10. Eroschenko V. Di Fiore’s atlas of histology with functional correlations. 11th ed. Baltimore: Lippincott Williams&Wilkins; 2008.
11. Folkov B., Nil E. Krovoobrashchenie. [Blood circulation]. Moscow: Meditsina Publishers; 1976: 463. [In Russ.]
12. De Backer D., Donadello K., Taccone F.S., OspinaTascon G., Salgado D., Vincent J.L. Microcirculatory alterations: potential mechanisms and implications for therapy. Ann. Intensive Care. 2011; 1 (1): 27. http://dx.doi.org/10.1186/21105820127. PMID: 21906380
13. Bateman R.M., Sharpe M.D., Ellis C.G. Benchtobedside review: Microvascular dysfunction in sepsis –hemodynamics, oxygen transport, and nitric oxide. Crit. Care. 2003; 7 (5): 359–373. http://dx.doi.org/10.1186/cc2353. PMID: 12974969
14. Pokrovsky V.I. (red.). Entsiklopedichesky slovar meditsinskikh terminov. 2e izd. [Encyclopedic dictionary of medical terms. 2nd ed.]. Moscow: Meditsina Publishers; 2001: 960. [In Russ.]
15. Furchgott R.F., Zawadski J.V. The obligatory role of endothelial cells in relaxation of arterial smooth muscle by acetylcholine. Nature. 1980; 288 5789): 373–376. http://dx.doi.org/10.1038/288373a0. PMID: 6253831
16. Ignarro L.J., Buga G.M., Wood K.S., Byrns R.E., Chaudhuri G. Endothelium derived relaxing factor produced and released from artery and vein is nitricoxide. Proc. Natl. Acad. Sci. USA. 1987; 84 (24): 9265–9269. http://dx.doi.org/10.1073/pnas.84.24.9265. PMID: 2827174
17. Barakat A.I. Responsiveness of vascular endothelium to shear stress: potential role of ion channels and cellular cytoskeleton (review). Int. J. Mol. Med. 1999; 4 (4): 323–332. http://dx.doi.org/10.3892/ijmm.4.4. 323. PMID: 10493972
18. Secomb T.W. Theoretical models for regulation of blood flow. Microcirculation. 2008; 15 (8): 765–775. http://dx.doi.org/10. 1080/10739680802350112. PMID: 18951240
19. Collins D.M., McCullough W.T., Ellsworth M.L. Conducted vascular responses: communication across the capillary bed. Microvasc. Res. 1998; 56 (1): 43–53. http://dx.doi.org/10.1006/mvre.1998.2076. PMID: 9683562
20. Moroz V.V., Ostapchenko D.A., Meshcheryakov G.N., Radaev S.M. Ostraya krovopoterya. Vzglyad na problemu. [Acute hemorrhage. View on the problem]. Anesteziologiya i Reanimatologiya. 2002; 6: 4–9. PMID: 12611147. [In Russ.]
21. Gutierrez G., Reines H.D., WulfGutierrez M.E. Clinical review: hemor rhagic shock. Crit. Care. 2004; 8 (5): 373–381. PMID: 15469601
22. Vorobyev A.I., Gorodetsky V.M., Shulutko E.M., Vasilyev S.A. Ostraya massivnaya krovopoterya. [Acute massive hemorrhage]. Moscow: GEOTARMED; 2001: 176. [In Russ.]
23. Zilber A.P. Krovopoterya i gemotransfuziya. Printsipy i metody beskrovnoi khirurgii. [Blood loss and transfusion. The principles and methods of bloodless surgery]. Petrozavodsk: izdvo Petrozavodskogo Gosudarstvennogo Universiteta; 1999: 114. [In Russ.]
24. Novitsky V.V., Goldberg E.D., Urazova O.I. (red.). Patofiziologiya. 4e izd. [Pathophysiology. 4th ed.]. Moscow: GEOTARMedia; 2009. [In Russ.]
25. Kozhura V.L., Novoderzhkina I.S., Kirsanova A.K. Ostraya massivnaya krovopoterya: mekhanizmy kompensataii. [Acute and massive hemorrhage: mechanisms of compensation and damage]. Anesteziologiya i Reanimatologiya. 2002; 6: 9–13. PMID: 12611148. [In Russ.]
26. Moore F.D. The effects of hemorrhage on body composition. N. Engl. J. Med. 1965; 273: 567–577. PMID: 14329627
27. Gann D.S. Endocrine control of plasma protein and volume. Surg. Clin. North. Am. 1976; 56 (5): 1135–1145. PMID: 185730
28. Darlington D.N., Jones R.O., Marzella L., Gann D.S. Changes in region al vascular resistance and blood volume after hemorrhage in fed and fasted awake rats. J. Appl. Physiol. 1995; 78 (6): 2025–2032. PMID: 7665395
29. Rocha E., Silva M.Jr., Rosenberg M. The release of vasopressin in response to haemorrhage and its role in the mechanism of blood pressure regulation. J. Physiol. 1969; 202 (3): 535–557. PMID: 5789937
30. Moroz V.V., Chernysh A.M., Kozlova E.K., Kirsanova A.K., Novoderzhkina I.S., Aleksandrin V.V., Rysaeva R.M. Atomnaya silovaya mikroskopiya membran eritrotsitov pri ostroi krovopotere i reinfuzii. Obshchaya Reanimatologiya. [Atomic force microscopy of the structure of red blood cell membranes in acute blood loss and reinfusion. General Reanimatology]. 2009; 5 (5): 5–9. http://dx.doi.org/10.15360/18139779200955. [In Russ.]
31. Moroz V.V., Novoderzhkina I.S., Antoshina E.M., Afanasyev A.V., Ryzhkov I.A., Zarzhetsky Yu.V. Korrektsiya poikilotsitoza i biokhimich eskikh pokazatelei krovi pri ostroi krovopotere. Obshchaya Reanimatologiya. [Correction of poikylocytosis and blood biochemical indicators in acute blood loss. General Reanimatology]. 2015; 11 (3): 6–15. http://dx.doi.org/10.15360/1813977920153615. [In Russ.]
32. Moroz V.V., Myagkova E.A., Sergunova V.A., Gudkova O.E., Ostapchenko D.A., Chernysh A.M., Reshetnyak V.I. Morfologicheskie osobennosti eritrotsitov u bolnykh s tyazheloi sochetannoi travmoi. Obshchaya Reanimatologiya. [Morphological features of red blood cells in patients with severe concomitant injury. General Reanimatology]. 2013; 9 (3):14–23. http://dx.doi.org/10.15360/181397792013314. [In Russ.]
33. Fitzsimons J.T. Angiotensin, thirst, and sodium appetite. Physiol. Rev. 1998; 78 (3): 583–686. PMID: 9674690
34. Prasad K., Lee P. Role of oxyradicals in the pathophysiology of hemor rhagic shock. Int. J. Angiol. 2002; 11 (3): 113–128. http://dx.doi.org/10.1007/s0054700209373
35. Volkov A.V., Avrushchenko M.Sh., Gorenkova N.A., Zarzhetsky Yu.V. Znachenie polovogo dimorfizma i reproduktivnykh gormonov v patogeneze i iskhode postreanimatsionnoi bolezni. Obshchaya Reanimatologiya. [Implication of sexual dimorphism and reproductive hormones in the pathogenesis and outcome of postresuscitative disease. General Reanimatology]. 2006; 2 (5–6): 70–78. http://dx.doi.org/ 10.15360/18139779200667078. [In Russ.]
36. Zarzhetsky Yu.V., Volkov A.V. Nekotorye voprosy patogeneza i terapiiterminalnykh i postreanimatsionnykh sostoyanii (eksperimentalnye issledovaniya. Obshchaya Reanimatologiya. [Some problems of the pathogenesis and therapy of terminal and postresuscitation conditions (experimental studies). General Reanimatology]. 2012; 8 (4): 55–68. http://dx.doi.org/10.15360/181397792012455. [In Russ.]
37. Tsukada K., Hasegawa T., Tsutsumi S., Kuwano H. Roles of cyclooxyge nase2 in tissue injury during hemorrhagic shock. Shock. 2000; 13 (5): 392–396. http://dx.doi.org/10.1097/0002438220000500000008. PMID: 10807015
38. Marino P.L. Intensivnaya terapiya. [Intensive therapy]. Moscow: GEOTARMedia; 2010: 768. [In Russ.]
39. Adachi H., Strauss W., Ochi H., Wagner H.N.Jr. The effect of hypoxia on the regional distribution of cardiac output in the dog. Circ. Res. 1976; 39 (3): 314–319. http://dx.doi.org/10.1161/01.RES.39.3.314. PMID: 954160
40. Gutierrez G., Marini C., Acero A.L., Lund N. Skeletal muscle PO2 during hypoxemia and isovolemic anemia. J. Appl. Physiol. 1990; 68 (5): 2047–2053. PMID: 2361907
41. Schwartz S., Frantz R.A., Shoemaker W.C. Sequential hemodynamic and oxygen transport responses in hypovolemia, anemia, and hypoxia. Am. J. Physiol. 1981; 241 (6): H864–H871. PMID: 7325255
42. Nelson D.P., King C.E., Dodd S.L., Schumacker P.T., Cain S.M. Systemic and intestinal limits of O2 extraction in the dog. J. Appl. Physiol. 1987; 63 (1): 387–394. PMID: 3114223
43. Weiskopf R.B., Viele M.K., Feiner J., Kelley S., Lieberman J., Noorani M., Leung J.M., Fisher D.M., Murray W.R., Toy P., Moore M.A. Human cardiovascular and metabolic response to acute, severe isovolemic anemia. JAMA. 1998; 279 (3): 217–221. http://dx.doi.org/10.1001/jama.279.3.217. PMID: 9438742
44. Erecin´ska M., Silver I.A. Tissue oxygen tension and brain sensitivity to hypoxia. Respir. Physiol. 2001; 128 (3): 263–276. PMID: 11718758
45. Dubin A., Estenssoro E., Murias G., Canales H., Sottile P., Badie J., Bara´n M., Pa´lizas F., Laporte M., Rivas Díaz M. Effects of hemorrhage on gastrointestinal oxygenation. Intensive Care Med. 2001; 27 (12): 1931–1936. http://dx.doi.org/10.1007/s0013400111389. PMID: 11797030
46. Khramykh T.P., Dolgikh V.T. Patogenez intoksikatsii pri gemorragich eskoi gipotenzii (eksperimentalnoe issledovanie). Obshchaya Reanimatologiya. [Pathogenesis of intoxication in hemorrhagic hypotension (an experimental study). General Reanimatology]. 2008; 4 (5): 36–39. http://dx.doi.org/10.15360/181397792008536. [In Russ.]
47. Torres Filho I.P., Torres L.N., Pittman R.N. Early physiologic responses to hemorrhagic hypotension. Transl. Res. 2010; 155 (2): 78–88. http://dx.doi.org/10.1016/j.trsl.2009.09.001. PMID: 20129488
48. Dolgikh V.T., Razgonov F.I., Shikunova L.G. Aktivatsiya protsessov lipoperoksidatsii pri ostroi smertelnoi krovopotere i povrezhdenie serdtsa. Obshchaya Reanimatologiya. [Acute fatal hemorrhageinduced activation of lipid peroxidation processes and cardiac lesion. General Reanimatology]. 2006; 2 (56): 50–54. http://dx.doi.org/10.15360/18139779200665054. [In Russ.]
49. Orlov Yu.P., Ivanov A.V., Dolgikh V.T., Lukach V.N., Chesnokova M.V., Pritykina T.V., Petrova Yu.A., Verbitskaya V.S., Sineokov S.A. Narusheniya obmena zheleza v patogeneze kriticheskikh sostoyanii (eksperimentalnoe issledovanie). Obshchaya Reanimatologiya. [Impaired iron metabolism in the pathogenesis of critical conditions (an experimental study). General Reanimatology]. 2011; 7 (5): 15–19. http://dx.doi.org/10.15360/1813 97792011515 2011515. [In Russ.]
50. Moroz V.V., Myagkova E.A., Zhanataev A.K., Ryabov G.A., Ostapchenko D.A., Durnev A.D., Reshetnyak V.I. Povrezhdeniya DNK i protsessy kletochnoi gibeli leikotsitov u postradavshikh s tyazheloi travmoi. Obshchaya Reanimatologiya. [DNA damages and white blood cell death processes in victims with severe injury. General Reanimatology]. 2014; 10 (4): 11–36. http://dx.doi.org/10.15360/18139779201441136. [In Russ.]
51. Kozhura V.L., Kondakova N.V., Zaichkina S.I., Rozanova O.M. Destabilizatsiya genoma pri deistvii ioniziruyushchei radiatsii i ostroikrovopoteri. Obshchaya Reanimatologiya. [Genome destabilization upon exposure to ionizing radiation and during acute blood loss. General Reanimatology]. 2007; 3 (1): 5–11. http://dx.doi.org/10.15360/1813977920071511. [In Russ.]
52. Hoeft A., Wietasch J.K., Sonntag H., Kettler D. Theoretical limits of «permissive anemia». Zentralbl Chir. 1995; 120 (8): 604613. PMID: 7571892
53. Mellander S., Lewis D.H. Effect of hemorrhagic shock on the reactivity of resistance and capacitance vessels and on capillary filtration transferin cat skeletal muscle. Circ. Res. 1963; 13: 105–118. http://dx.doi.org/10.1161/01.RES.13.2.105. PMID: 14054776
54. Gerasimov L.V., Moroz V.V., Isakova A.A. Mikroreologicheskie narusheniya pri kriticheskikh sostoyaniyakh. Obshchaya Reanimatologiya. [Microrheological disorders in critical conditions. General Reanimatology]. 2010; 6 (1): 74–78. http://dx.doi.org/10.15360/181397792010174. [In Russ.]
55. Mantskava M.M., Momtselidze N.G., Davlianidze A.Sh. Reologicheskie svoistva krovi pri krovopotere (eksperimentalnoe issledovanie). Obshchaya Reanimatologiya. [Blood rheological properties in blood loss (an experimental study). General Reanimatology]. 2014; 10 (5): 27–32. http://dx.doi.org/10.15360/18139779201452732. [In Russ.]
56. Moroz V.V., Golubev A.M., Afanasyev A.V., Kuzovlev A.N., Sergunova V.A., Gudkova O.E., Chernysh A.M. Stroenie i funktsiya eritrotsita v norme i pri kriticheskikh sostoyaniyakh. Obshchaya Reanimatologiya. [The structure and function of a red blood cell in health and critical conditions. General Reanimatology]. 2012; 8 (1): 52–60. http://dx.doi.org/10.15360/181397792012152. [In Russ.]
57. Moroz V.V., Sergunova V.A., Nazarov B.F., Kozlova E.K., Chernysh A.M., Vlasov I.B. Izmeneniya nanostruktury membran krasnykh kletok krovi pri krovopotere na etapakh khirurgicheskogo lecheniya u bolnykh pri operatsiyakh na spinnom mozge. Obshchaya Reanimatologiya. [Changes in the nanostructure of red blood cells in intraoperative blood loss during spinal cord surgery. General Reanimatology]. 2013; 9 (2): 5–11. http://dx.doi.org/10.15360/18139779201325. [In Russ.]
58. Moroz V.V., Chernysh A.M., Kozlova E.K., Sergunova V.A., Gudkova O.E., Fedorova M.S., Kirsanova A.K., Novoderzhkina I.S. Narusheniya nanostruktury membran eritrotsitov pri ostroi krovopotere i ikh korrektsiya perftoruglerodnoi emulsiei. Obshchaya Reanimatologiya. [Impairments in the nanostructure of red blood cell membranes in acute blood loss and their correction with perfluorocarbon emulsion. General Reanimatology]. 2011; 7 (2): 5–9. http://dx.doi.org/10. 15360/18139779201125. [In Russ.]
59. Kozlova E., Chernysh A., Moroz V., Sergunova V., Zavialova A., Kuzovlev A. Nanoparticles of perfluorocarbon emulsion contribute to the reduction of methemoglobin to oxyhemoglobin. Int. J. Pharm. 2016; 497: 88–95. http://dx.doi.org/10.1016/j.ijpharm.2015.11.035. PMID: 26626224
60. Peitzman A.B., Billiar T.R., Harbrecht B.G., Kelly E., Udekwu A.O., Simmons R.L. Hemorrhagic shock. Curr. Probl. Surg. 1995; 32 (11): 925–1002. http://dx.doi.org/10.1016/S00113840(05)800085. PMID: 7587344
61. Kosovskikh A.A., Churlyaev Yu.A., Kan S.L., Lyzlov A.N., Kirsanov T.V., Vartanyan A.R. Tsentralnaya gemodinamika i mikrotsirkulyatsiya pri kriticheskikh sostoyaniyakh. Obshchaya Reanimatologiya. [Central hemodynamics and microcirculation in critical conditions. General Reanimatology]. 2013; 9 (1): 18–22. http://dx.doi.org/10.15360/181397792013118. [In Russ.]
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Moroz V.V., Ryzhkov I.A. Acute Blood Loss: Regional Blood Flow and Microcirculation (Review, Part I). General Reanimatology. 2016;12(2):66-89. https://doi.org/10.15360/1813-9779-2016-2-66-89
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