부산대학교 도서관

Blast injury is a dominant and increasing mode of battlefield injuries. The resulting complex injury pattern may include hypoxia due to primary blast lung injury and haemorrhage due to severe secondary and tertiary blast injuries. It has been previously shown that hypotensive resuscitation, as recommended by NICE for pre-hospital trauma resuscitation, is not compatible with survival over extended evacuation times following combined blast injury and haemorrhage, due to underlying inadequacy of systemic tissue oxygen delivery. This thesis investigates a hybrid resuscitation strategy, utilising a novel target blood pressure profile of hypotension (SBP 80 mmHg) for one hour followed by normotension (SBP 110 mmHg). This strategy, termed novel hybrid resuscitation (NH), was investigated with an in vivo model of terminally anesthetised pigs exposed to either a blast shock wave or sham blast, followed by severe controlled haemorrhage plus uncontrolled haemorrhage from a grade IV liver injury. In this model of survivable battlefield injury, NH resuscitation using 0.9% saline demonstrated superiority over hypotensive resuscitation for extended evacuation times (up to 8 hours), with significantly improved survival time after combined blast injury and haemorrhage (from 258 to 452 minutes, mean, p=0.0169) and a clinically significant improvement in physiological state after haemorrhage in the absence of blast. There was no evidence of increased re- bleeding associated with NH. The use of hypertonic saline dextran (HSD) as the initial resuscitation fluid in an NH strategy was also assessed. Although HSD did show some physiological benefit after haemorrhage in the absence of blast injury, survival time was Significantly shorter when animals were initially resuscitated with HSD after combined blast and haemorrhage (208 minutes, mean, p=0.04). The reason remains unclear. In conclusion, NH should be considered as an emergency measure when delayed casualty evacuation is enforced. However HSD should be contraindicated when significant primary blast injury complicates haemorrhage.