Oxygen Transport System and Its Compensatory Capabilities for Victims During Operations for Abdominal Trauma, Complicated by Blood Loss

Abstract

Background. Acute hemorrhage remains the leading cause of death on the operating room in emergency surgery. However, the correlation of the central hemodynamics, oxygen balance and homeostasis in such victims during emergency surgical treatment with the outcomes of surgical treatment has not yet been evaluated.Material and methods. We examined 100 patients with acute massive blood loss, who had emergency surgery. We determined heart rate, arterial pressure by direct and indirect methods, central venous pressure, oxygen saturation of blood, cardiac index, systemic vascular resistance, gas and acid-base contents of arterial and venous blood, oxygen consumption, oxygen delivery, oxygen extraction ratio according to generally accepted formulas. Two groups of patients were formed of 50 people, depending on the oxygen balance (Group 1 - subcompensation, Group 2 - decompensation).Results. At the time of admission to the operating room and after the surgery, the indicators of systemic hemodynamics in patients of both groups did not differ statistically significantly. In the Group 2, at the time of admission to the operating room, there were statistically significantly higher VO2 (195 (158, 256) ml/(min-m2) and 112.5 (86; 145.3) ml/(min-m2)), ERO2 (50 (45.1, 60) % and 25.1 (19.6, 33.2) %) and low SvO2 (54.4 (48.5, 67.5) % and 75.1 (67,8; 83) %) (p<0.001 for all indicators). In the Group 2, there were increased values of ERO2 and VO2 (p=0.001) at the end of the operation compared to the Group 1, although the glucose and lactate levels did not differ statistically significantly between the groups. The course of the postoperative period was complicated in 9 (18%) patients of the Group 1 and 2 (4%) patients died. The course of the postoperative period of patients in the Group 2 was complicated in 9 (18%) patients and 7 (14%) patients died.Conclusion . Circulatory insufficiency persisted in patients who had severe oxygen deficiency disorders, despite management of bleeding, replenishment of blood loss, intraoperative intensive therapy, indicating the depletion of the compensatory mechanisms of the oxygen transport system. This was confirmed by a higher mortality rate among the victims of this group.

Keywords

• oxygen balance
• acute massive hemorrhage
• oxygen consumption
• oxygen delivery
• oxygen extraction ratio