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Signa Vitae

Journal of Anaesthesia, Intensive Care and Emergency Medicine

The effect of erythropoietin on chloride levels during hypoxia reoxygenation injury in rats


Objective. This experimental study examined the effect of erythropoietin (Epo) in a rat model and particularly in a hypoxia-reoxygenation (HR) protocol. The effect of that molecule was studied biochemically using blood mean chloride (Cl) levels.

Materials and methods. 40 rats of mean weight 247.7 g were used in the study. Cl levels were measured at 60 min (groups A and C) and at 120 min (groups B and D) of reoxygenation. Erythropoietin was administered only in groups C and D.

Results. Epo administration non-significantly decreased Cl levels by 1.07%+0.91% (p=0.2635). Reoxygenation time non-significantly decreased Cl levels by 0.68%+0.92% (P= 0.4457). However, erythropoietin administration and reoxygenation time together produced a non-significant combined effect in decreasing Cl levels by 0.74%+0.54% (P= 0.1701).

Conclusions. Epo administration, reoxygenation time and their interaction have non-significant, short-term, decreasing effects on Cl levels.

Key words: chloride, hypoxia, erythropoietin, reoxygenation

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Impact of pre-hospital oxygenation and ventilation status on outcome in patients with isolated severe traumatic brain injury


Introduction. Hypoxia is one of the secondary insults and it worsens the outcome in patients with severe traumatic brain injury (TBI). On the other hand, there is some controversy about the impact of hyperoxia on the outcome in these patients. The aim of the study was to determine the impact of pre-hospital hypoxia, hyperoxia and pre-hospital ventilation status on outcome after isolated TBI.

Methods. We retrospectively reviewed charts from patients with isolated severe TBI who underwent pre-hospital endotracheal intubation. The population was sorted into groups based on PaO2 (hypoxic, PaO2 <100 mmHg; normoxic, PaO2 100-200 mmHg; hyperoxic, PaO2 > 200 mmHg) and initial Glasgow Coma Scale (GCS) level (3-5 and ≥ 6). Ventilation status was defined as: hypocarbic (PaCO2 < 35 mmHg), normocarbic (PaCO2 35-45 mmHg) and hypercarbic (PaCO2 > 45 mmHg).

Results. Oxygenation status had no significant impact on 24- and 48-hour survival, on the length of hospital stay or on neurological outcome (measured by the Glasgow Outcome Scale (GOS), Glasgow Pittsburgh Cerebral Performance Categories Scale (CPC), and GCS score at discharge) when all six groups were compared together. We were unable to prove a deleterious effect of hypoxia or hyperoxia compared to normoxia on rate of survival to hospital discharge (STHD) (0.38 (0.52) vs 0.50 (0.51) vs 0.65 (0.49), where 0 – no and 1 – yes; f = 1.246, p = 0.298). Ventilation status also failed to significantly affect survival and functional outcome in patients with isolated severe TBI.

Conclusion. Pre-hospital oxygenation and ventilation status have no significant impact on outcome in patients with isolated severe TBI.

Key words: hypoxia, pre-hospital, intubation, hyperventilation, traumatic brain injury

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Erythropoietin in post-resuscitation neurological recovery: is there light at the end of the tunnel?


Studies show that erythropoietin, besides its critical role in hematopoiesis, provides neuroprotection in hypoxic-ischemic cerebral injury. Antiapoptotic, anti-inflammatory, angiogenetic, and neurotrophic properties of erythropoietin could increase indications, currently restricted to anemia in chronic renal failure and cancer, to hypoxic-ischemic cerebral insult.
In the adult and neonatal animal model of hypoxic-ischemic cerebral injury, erythropoietin significantly reduces infarct size with attenuation of brain damage, and preservation of cortical integrity. The first human study on the impact of erythropoietin in stroke victims showed that erythropoietin is safe and well tolerated at high doses, and associated with improved neurological outcome. Even with intravenous application, concentrations of erythropoietin in cerebrospinal fluid of these patients were many-fold higher than in non-treated patients.
In successfully resuscitated cardiac arrest victims overall neurological recovery remains poor despite improved cardiopulmonary resuscitation strategies. Post-resuscitation care needs further advances in order to improve final outcome. Through promotion of neuroangiogenesis, inhibition of hypoxia-induced apoptosis in neurons, and thus support of the survival of neurons in the ischemic brain, erythropoietin could be used to improve functional recovery of these patients. Nevertheless, optimal molecular forms of EPO, therapeutic doses, and treatment time window have to be determined in order to lower the incidence of adverse effects and still preserve neuroprotective properties.

Key words: cardiopulmonary resuscitation, erythropoietin, post-resuscitation period, hypoxia.

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