HemorrhageTremlEtAl
Description
In Treml, et al. 65% of blood was removed from the pig over 20 minutes from the femoral artery. Data was collected prior to blood removal, immediately after blood was removed and 1 hour after blood removal.
Pulse cannot replicate this. It is too much blood loss for the Pulse model and results in cardiovascular collapse. Therefore, to replicate this, just under 50% blood loss in the was applied. To remove this in 20 min is a rate of 100 ml/min. That is too much for femoral artery, so will split between femoral and vena cava.
This is a link to Treml, 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.
| Property Name | Validation | Engine Value | Percent Error | Percent Change | Notes |
|---|---|---|---|---|---|
| HeartRate(1/min) | EqualTo 89 [384] | 83.9 | -5.68% | ||
| SystolicArterialPressure(mmHg) | EqualTo 105 [384] | 106 | 1.10% | ||
| MeanCentralVenousPressure(mmHg) | EqualTo 9 [384] | 4.25 | -52.72% | ||
| PulmonaryMeanArterialPressure(mmHg) | EqualTo 26 [384] | 15.7 | -39.75% | ||
| PulmonaryCapillariesWedgePressure(mmHg) | EqualTo 11 [384] | 5.42 | -50.77% | ||
| CardiacOutput(L/min) | EqualTo 5.1 [384] | 5.16 | 1.10% | ||
| Aorta-Oxygen-PartialPressure(mmHg) | EqualTo 74 [384] | 89.9 | 21.51% | ||
| Aorta-CarbonDioxide-PartialPressure(mmHg) | EqualTo 37 [384] | 33.9 | -8.30% | ||
| ClinicalShuntFraction | EqualTo 0.039 [384] | 0.0353 | -9.56% | ||
| BloodVolume(mL) | EqualTo 4200 [384] | 4.22e+03 | 0.49% | ||
| Lactate-BloodConcentration(mg/dL) | EqualTo 15 [128] | 15.5 | 3.65% | ||
| TotalHemorrhagedVolume(mL) | EqualTo 0 [384] | 0.00 | 0.00% |
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Segment 2
Initiate a hemorrhage corresponding to 65% blood loss over 20 minutes. Cannot achieve this in Pulse, so did just under 50%. Initiate a hemorrhage corresponding to 65% blood loss over 20 minutes. Cannot achieve this in Pulse, so did just under 50%. Simulate for 20 minutes.
| Property Name | Validation | Engine Value | Percent Error | Percent Change | Notes |
|---|---|---|---|---|---|
| HeartRate(1/min) | EqualTo 1.7*Segment1 (143) [384] | 145 | 1.72% | ||
| SystolicArterialPressure(mmHg) | EqualTo 0.45*Segment1 (47.8) [384] | 38.3 | -19.87% | ||
| MeanCentralVenousPressure(mmHg) | EqualTo -3 [384] | 2.48 | 182.72% | ||
| PulmonaryMeanArterialPressure(mmHg) | EqualTo 0.31*Segment1 (4.86) [384] | 5.08 | 4.71% | ||
| PulmonaryCapillariesWedgePressure(mmHg) | EqualTo 0.27*Segment1 (1.46) [384] | 3.94 | 169.65% | ||
| CardiacOutput(L/min) | EqualTo 0.51*Segment1 (2.63) [384] | 1.67 | -36.55% | ||
| Aorta-Oxygen-PartialPressure(mmHg) | EqualTo 1.08*Segment1 (97.1) [384] | 77.1 | -20.64% | ||
| Aorta-CarbonDioxide-PartialPressure(mmHg) | EqualTo 0.86*Segment1 (29.2) [384] | 39.5 | 35.40% | ||
| ClinicalShuntFraction | EqualTo 0.33*Segment1 (0.0116) [384] | 0.0247 | 112.09% | ||
| BloodVolume(mL) | EqualTo 1480 [384] | 2.23e+03 | 50.96% | ||
| Lactate-BloodConcentration(mg/dL) | EqualTo 2.93*Segment1 (45.6) [128] | 26.7 | -41.47% | ||
| TotalHemorrhagedVolume(mL) | EqualTo 2720 [384] | 2.00e+03 | -26.47% |
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Segment 3
Stop the controlled hemorrhages. Stop the controlled hemorrhages. Simulate for 60 minutes.
| Property Name | Validation | Engine Value | Percent Error | Percent Change | Notes |
|---|---|---|---|---|---|
| HeartRate(1/min) | EqualTo 1.09*Segment2 (158) [384] | 145 | -8.37% | ||
| SystolicArterialPressure(mmHg) | EqualTo 1.11*Segment2 (42.5) [384] | 38.4 | -9.74% | ||
| MeanCentralVenousPressure(mmHg) | EqualTo 0 [384] | 2.56 | inf% | ||
| PulmonaryMeanArterialPressure(mmHg) | EqualTo 1.63*Segment2 (8.29) [384] | 5.20 | -37.25% | ||
| PulmonaryCapillariesWedgePressure(mmHg) | EqualTo 0.67*Segment2 (2.64) [384] | 4.03 | 52.49% | ||
| CardiacOutput(L/min) | EqualTo 0.77*Segment2 (1.28) [384] | 1.71 | 32.97% | ||
| Aorta-Oxygen-PartialPressure(mmHg) | EqualTo 1.13*Segment2 (87.1) [384] | 77.0 | -11.57% | ||
| Aorta-CarbonDioxide-PartialPressure(mmHg) | EqualTo 1.19*Segment2 (47.0) [384] | 45.1 | -4.07% | ||
| ClinicalShuntFraction | EqualTo 0.59*Segment2 (0.0146) [384] | 0.0241 | 65.66% | ||
| BloodVolume(mL) | EqualTo 1480 [384] | 2.25e+03 | 52.04% | ||
| Lactate-BloodConcentration(mg/dL) | EqualTo 2.16*Segment2 (57.6) [128] | 161 | 178.97% | ||
| TotalHemorrhagedVolume(mL) | EqualTo 2720 [384] | 2.00e+03 | -26.47% |
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Scenario Output Plots
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