HemorrhageSollerEtAlNonSurvivors

Description

Replicating the experiment in Soller et al for the group of survivor swine. Swine were given a controlled bleed for 15 minutes at a rate of 24 ml/kg. The controlled bleed was stopped and a spleen injury was applied for an uncontrolled bleed. After 15 additional minutes, fluids were given (assuming saline) to maintain mAP at 65 mmHg (measured MAP was not 65 throughout study). Measurements were taken at 0 minutes (end of uncontrolled hemorrhage), 15 minutes, 60 minutes and 120 minutes. The amount of blood lost and the amount of fluid given was also recorded at these intervals allowing us to replicate the experiment.

Hemorrhage Soller Et Al NonSurvivors

Description

Replicating the experiment in Soller et al for the group of survivor swine. Swine were given a controlled bleed for 15 minutes at a rate of 24 ml/kg. The controlled bleed was stopped and a spleen injury was applied for an uncontrolled bleed. After 15 additional minutes, fluids were given (assuming saline) to maintain mAP at 65 mmHg (measured MAP was not 65 throughout study). Measurements were taken at 0 minutes (end of uncontrolled hemorrhage), 15 minutes, 60 minutes and 120 minutes. The amount of blood lost and the amount of fluid given was also recorded at these intervals allowing us to replicate the experiment.

This is a link to Soller, et al.

Segment Validation

Segment 1

Lungs were mechanically ventilated in volume-controlled mode with a FiO2 of 0.21 and a PEEP of 5 cm H2O. Tidal volumes were adjusted to 7 to 10 mL/kg at 15 breaths per minute (fixed rate) to achieve a PaCO2 between 35 mmHg and 40 mmHg.

Mode	VT (L)	Flow (L/min)	TI (s)	RR (bpm)	PEEP (cmH2O)	FiO2
VC-CMV	0.475	29	1.0	15	5	0.21

Run to homeostasis. Initiate a controlled hemorrhage corresponding to 24 mL/kg for a 59 kg female pig. 59kg*24 ml/kg = 1416 ml -> / 15 min = 94.4 ml/min. This was distributed across the femoral artery and the vena cava. Simulate for 15 minutes.

Table 1. Data request validation results for Segment 1.

Property Name	Validation	Engine Value	Percent Error
HeartRate(1/min)	EqualTo 114 [361]	115	0.59%
MeanArterialPressure(mmHg)	EqualTo 68 [361]	77.7	14.28%
BloodVolume(mL)	EqualTo 2800 [361]	2.81e+03	0.37%
CardiacOutput(mL/min)	EqualTo 4400 [361]	3.45e+03	-21.58%
Hemoglobin-BloodConcentration(g/dL)	EqualTo 9.7 [361]	13.8	42.38%
TotalHemorrhagedVolume(mL)	EqualTo 1400 [361]	1.42e+03	1.14%
BloodPH	EqualTo 7.3 [361]	7.37	0.96%
VenaCava-Lactate-Molarity(mmol/L)	EqualTo 2.1 [361]	2.08	-0.77%

Figure 1. Vitals monitor for Segment 1.

Segment 2

Stop the controlled hemorrhages. Stop the controlled hemorrhages. Initiate an uncontrolled spleen hemorrhage corresponding to 8 mL/kg for a 59 kg female pig. 59kg*8 ml/kg = 472ml -> / 15 min = 31.5 ml/min. Simulate for 15 minutes.

Table 2. Data request validation results for Segment 2.

Property Name	Validation	Engine Value	Percent Error
HeartRate(1/min)	EqualTo 1.82*Segment1 (209) [361]	124	-40.83%
MeanArterialPressure(mmHg)	EqualTo 0.54*Segment1 (42.0) [361]	35.0	-16.69%
BloodVolume(mL)	EqualTo 2325 [361]	2.34e+03	0.70%
CardiacOutput(mL/min)	EqualTo 0.34*Segment1 (1.17e+03) [361]	1.54e+03	31.41%
Hemoglobin-BloodConcentration(g/dL)	EqualTo 1.01*Segment1 (13.9) [361]	13.8	-1.14%
TotalHemorrhagedVolume(mL)	EqualTo 1872 [361]	1.89e+03	0.88%
BloodPH	EqualTo 0.98*Segment1 (7.22) [361]	7.36	1.91%
VenaCava-Lactate-Molarity(mmol/L)	EqualTo 1.9*Segment1 (3.96) [361]	4.70	18.61%

Figure 2. Vitals monitor for Segment 2.

Segment 3

Continue the uncontrolled hemorrhage corresponding to 15 mL/kg for a 59 kg female pig. 59kg*15 ml/kg = 885ml -> / 45 min = 20 ml/min. Initiate fluid resuscitation corresponding to 21 mL/kg for a 59 kg female pig. 59kg*21 ml/kg = 1239 ml -> / 45 min = 27.5 ml/min. Simulate for 45 minutes.

Table 3. Data request validation results for Segment 3.

Property Name	Validation	Engine Value	Percent Error
HeartRate(1/min)	EqualTo 1.02*Segment2 (126) [361]	123	-1.96%
MeanArterialPressure(mmHg)	EqualTo 1.03*Segment2 (36.0) [361]	35.0	-2.87%
BloodVolume(mL)	EqualTo 1860 [361]	1.95e+03	4.97%
CardiacOutput(mL/min)	EqualTo 0.95*Segment2 (1.46e+03) [361]	1.60e+03	9.19%
Hemoglobin-BloodConcentration(g/dL)	EqualTo 0.62*Segment2 (8.55) [361]	13.0	51.49%
TotalHemorrhagedVolume(mL)	EqualTo 2520 [361]	2.79e+03	10.65%
BloodPH	EqualTo 1.006*Segment2 (7.40) [361]	7.34	-0.85%
VenaCava-Lactate-Molarity(mmol/L)	EqualTo 1.825*Segment2 (8.57) [361]	13.8	61.25%

Figure 3. Vitals monitor for Segment 3.

Segment 4

Continue the uncontrolled hemorrhage corresponding to 0 mL/kg for a 59 kg female pig. 59kg*0 ml/kg = 59ml -> / 60 min = 0 ml/min. Initiate fluid resuscitation corresponding to 5 mL/kg for a 59 kg female pig. 59kg*5 ml/kg = 118ml -> / 60 min = 5 ml/min. Simulate for 60 minutes.

Table 4. Data request validation results for Segment 4.

Property Name	Validation	Engine Value	Percent Error
HeartRate(1/min)	EqualTo 1.01*Segment3 (125) [361]	123	-1.11%
MeanArterialPressure(mmHg)	EqualTo 0.92*Segment3 (32.2) [361]	56.8	76.51%
BloodVolume(mL)	EqualTo 1980 [361]	2.27e+03	14.56%
CardiacOutput(mL/min)	EqualTo 0.73*Segment3 (1.17e+03) [361]	2.64e+03	126.46%
Hemoglobin-BloodConcentration(g/dL)	EqualTo 1.6*Segment3 (20.7) [361]	11.1	-46.26%
TotalHemorrhagedVolume(mL)	EqualTo 1636 [361]	2.79e+03	70.44%
BloodPH	EqualTo 0.993*Segment3 (7.29) [361]	7.32	0.48%
VenaCava-Lactate-Molarity(mmol/L)	EqualTo 1.18*Segment3 (16.3) [361]	25.2	54.51%

Figure 3. Vitals monitor for Segment 4.

Scenario Output Plots

Figure 4. Select outputs from the scenario.