Cardiopulmonary response to intraperitoneal instillation of autologous unclotted blood in hemorrhagic shock.

Adult respiratory distress syndrome has been described in patients following multiple trauma and hemorrhagic shock. Pure hemorrhagic shock in sheep does not lead to pulmonary dysfunction. To settle this seeming discrepancy, we hypothesized that an additional factor such as intraperitoneal blood was necessary to produce pulmonary dysfunction. Twenty-two sheep prepared by hemodynamic and lung lymphatic cannulation were divided into three groups. In group I (n = 7) hemorrhagic shock of 50 torr for 2 hr was induced by arterial bleeding. In group II (n = 12) hemorrhagic shock was induced as in group I, and 200 ml of autologous unclotted blood was infused into the peritoneal cavity. In group III (n = 3) 200 ml of unclotted shed blood was infused intraperitoneally and 200 ml NaCl 0.9% infused intravenously. Intraperitoneal infusion of 200 ml of shed blood in normal animals did not alter pulmonary hemodynamics, pulmonary shunting, lymph flow, or lymph protein clearance. Hemorrhagic shock was followed by a fall in cardiac index (CI) to 104 ml/min.kg (P less than 0.005), CVP to 0.4 torr (P less than 0.01) and rise in pulse rate to 127 per min (P less than 0.01). Blood hemoglobin decreased to 7.6 g/dl (P less than 0.0001) and platelets to 309,000/microliter (P less than 0.05). Pulmonary microvascular pressure fell to 6.7 torr (P less than 0.01) and pulmonary wedge pressure to 1.2 torr (P less than 0.005). These parameters were not altered by instillation of unclotted blood into the peritoneal cavity.(ABSTRACT TRUNCATED AT 250 WORDS)