Skip to main content
SpringerLink
Log in

Blood Flow Versus Hematocrit in Optimization of Oxygen Transfer to Tissue During Fluid Resuscitation

  • Published:
Cardiovascular Engineering and Technology Aims and scope Submit manuscript

Abstract

The effectiveness of fluid resuscitation regimens in hemorrhagic trauma is assessed based on its ability to increase oxygen concentration in tissue. Fluid resuscitation using both crystalloids and colloids fluids, creates a dilemma due to its opposing effects on oxygen transfer. It increases blood flow thereby augmenting oxygen transport but it also dilutes the blood simultaneously and reduces oxygen concentration thereby reducing oxygen transport. In this work we have studied these two opposing effects of fluid therapy on oxygen delivery to tissue. A mathematical model of oxygen diffusion from capillaries to tissue and its distribution in tissue was developed and integrated into a previously developed hemodynamic model. The capillary-tissue model was based on the Krogh structure. Compared to other models, fewer simplifying assumptions were made leading to different boundary conditions and less constraints, especially regarding capillary oxygen content at its venous end. Results showed that oxygen content in blood is the dominant factor in oxygen transport to tissue and its effect is greater than the effect of flow. The integration of the capillary/tissue model with the hemodynamic model that links administered fluids with flow and blood dilution indicated that fluid resuscitation may reduce oxygen transport to tissue.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Figure 1
Figure 2
Figure 3
Figure 4
Figure 5
Figure 6
Figure 7

Similar content being viewed by others

References

  1. American College of Surgeons. Advanced Trauma Life Support for Doctors (8th ed.). Chicago: American College of Surgeons, 2008.

    Google Scholar 

  2. Barnea, O., and N. Sheffer. A computer model for analysis of fluid resuscitation. Comput. Biol. Med. 23:443–454, 1993.

    Article  Google Scholar 

  3. Bickell, W., et al. Immediate versus delayed fluid resuscitation for hypotensive patients with penetrating torso injuries. N. Engl. J. Med. 331:1105–1109, 1994.

    Article  Google Scholar 

  4. Dash, R., and J. Bassingthwaighte. Simultaneous blood-tissue exchange of oxygen, carbon dioxide, bicarbonate, and hydrogen ion. Ann. Biomed. Eng. 34(7):1129–1148, 2006.

    Article  Google Scholar 

  5. Funk, W., and V. Baldinger. Microcirculatory perfusion during volume therapy. A comparative study using crystalloid or colloid in awake animals. Anesthesiology 82:975–982, 1995.

    Article  Google Scholar 

  6. Goldman, D. Theoretical models of microvascular oxygen transport to tissue. Microcirculation 15(8):795–811, 2008.

    Article  Google Scholar 

  7. Goldman, D., et al. Effect of decreased O2 supply on skeletal muscle oxygenation and O2 consumption during sepsis: role of heterogeneous capillary spacing and blood flow. Am. J. Physiol. Heart Circ. Physiol. 290:2277–2285, 2006.

    Article  Google Scholar 

  8. Guyton, C., and J. Hall. Textbook of Medical Physiology (11th ed.). Philadelphia: Elsevier Saunders, 2006.

  9. Huβmann, B., et al. Influence of prehospital fluid resuscitation on patients with multiple injuries in hemorrhagic shock in patients from the DGU trauma registry. J. Emerg. Trauma Shock 4(4):465–471, 2011.

    Google Scholar 

  10. Knotzer, H., et al. Comparison of lactated Ringer’s, gelatine and blood resuscitation on intestinal oxygen supply and mucosal tissue oxygen tension in haemorrhagic shock. Br. J. Anaesth. 97(4):509–516, 2006.

    Article  Google Scholar 

  11. Krogh, A. The number and distribution of capillaries in muscles with calculations of the oxygen pressure head necessary for supplying the tissue. J. Physiol. 52:409–415, 1919.

    Article  Google Scholar 

  12. Lang, K., et al. Colloids versus crystalloids, tissue oxygen tension in patients undergoing major abdominal surgery. Anesth. Analg. 93:405–409, 2001.

    Google Scholar 

  13. Li, Z., et al. Nonlinear model for capillary-tissue oxygen transport and metabolism. Ann. Biomed. Eng. 25:604–619, 1997.

    Article  Google Scholar 

  14. Middleman, S. Transport Phenomena in the Cardiovascular SystemWiley-Interscience Series on Biomedical Engineering, New York: Wiley, 1972.

    Google Scholar 

  15. Morrison, C., et al. Hypotensive resuscitation strategy reduces transfusion requirements and severe postoperative coagulopathy in trauma patients with hemorrhagic shock: preliminary results of a randomized controlled trial. J. Trauma 70:652–663, 2011.

    Article  Google Scholar 

  16. National Institute for Clinical Excellence “NHS”, Prehospital Initiation of Fluid Replacement Therapy in Trauma, Issue 2004, National Institute for Clinical Excellence, 2007.

  17. Perel, P., et al., Colloids versus crystalloids for fluid resuscitation in critically ill patients (Review). Cochrane Database Syst. Rev. 2, 2013.

  18. Popel, A. Theory of oxygen transport to tissue. Crit. Rev. Biomed. Eng. 17:257–321, 1989.

    Google Scholar 

  19. Schumacker, P., and R. Samsel. Analysis of oxygen delivery and uptake relationships in the Krogh tissue model. J. Appl. Physiol. 67(3):1234–1244, 1989.

    Google Scholar 

  20. Sharan, M., et al. A compartmental model for oxygen transport in brain microcirculation. Ann. Biomed. Eng. 17(1):13–38, 1989.

  21. Sharan, M., et al. Parametric analysis of the relation between end-capillary and mean tissue PO2 as predicted by a mathematical model. J. Theor. Biol. 195:439–449, 1998.

    Article  Google Scholar 

  22. Sharan, M., et al. A two layer model for studying the effect of plasma on the delivery of oxygen to tissue using a finite element method. Appl. Mater. Modelling 21:419–426, 1997.

    Article  MATH  Google Scholar 

  23. Shires, T., et al. Fluid therapy in haemorrhagic shock. Arch. Surg. 88:688–693, 1964.

    Article  Google Scholar 

  24. Siam, J., et al. Optimization of oxygen delivery in fluid resuscitation for hemorrhagic shock: a computer simulation study. Cardiovasc. Eng. Technol. 5(1):82–95, 2014.

    Article  Google Scholar 

  25. Wiggers, C. Experimental haemorrhage shock. In: Physiology of shock. New York: The Common wealth Fund, 1950, pp. 121–143.

  26. World Health Organization, Violence, Injuries, and Disabilities Biennial Report 2008–2009, WHO Library Cataloguing-in-Publication Data, 2010.

Download references

Conflict of Interest

No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.

Statement of Human Studies

The work did not involve human subjects or human embryonic stem cells.

Statement of Animal Studies

The work did not involve animal experiments or made use of tissues and cells.

Author information

Authors and Affiliations

  1. Department of Biomedical Engineering, Tel Aviv University, 6997801, Tel Aviv, Israel

    Jamal Siam, Marwa Kadan & Ofer Barnea

  2. Department of Intensive Care & Anesthesiology, Tel Aviv Sourasky Medical Center, and the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel

    Ron Flaishon

Authors
  1. Jamal Siam
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Marwa Kadan
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ron Flaishon
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Ofer Barnea
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jamal Siam.

Additional information

Associate Editor Ajit P. Yoganathan oversaw the review of this article.

Appendix

Appendix

See Table 1.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Siam, J., Kadan, M., Flaishon, R. et al. Blood Flow Versus Hematocrit in Optimization of Oxygen Transfer to Tissue During Fluid Resuscitation. Cardiovasc Eng Tech 6, 474–484 (2015). https://doi.org/10.1007/s13239-015-0237-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s13239-015-0237-7

Keywords

Search

Navigation