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Heart rate variability during massive hemorrhage and progressive hemorrhagic shock in dogs

Masaki Kawase, MD^*, Toru Komatsu, MD, Kimitoshi Nishiwaki, MD, Tomomasa Kimura, MD^*, Yoshihiro Fujiwara, MD^*, Toshimichi Takahashi, md^* and Yasuhiro Shimada, MD^*

^* From the Department of Anesthesiology, Nagoya University School of Medicine,
the Department of Anesthesiology and Acute Medicine, Aichi Medical University, and
the Department of Anesthesiology, the first Nagoya Red Cross Hospital, Japan.

Address correspondence to: Address correspondence to: Masaki Kawase MD, Department of Anesthesiology, Nagoya University School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya 466-8550, Japan. Phone: +81-52-744-2340; Fax: +81-52-744-2342; E-mail: FZA00627{at}niftyserve.or.jp

Purpose: To investigate the sequential changes in heart rate (HR), autonomic nervous activity presented by the spectral analysis of heart rate variability (HRV), hemodynamics and metabolism during massive hemorrhage and progressive hemorrhagic shock in dogs.

Methods: Twelve dogs were subjected to acute massive hemorrhage until mean arterial pressure (MAP) reached 50 mmHg. Then bleeding was stopped and they were allowed to reach a plateau phase. They were divided, post hoc, into bradycardic or tachycardic groups according to their HR response to the acute massive hemorrhage. After reaching a plateau phase, the dogs were further bled to keep their MAP around 50 mmHg (progressive hemorrhagic shock). Their heart rate power spectra were quantified into low-frequency (LF) (0.04-0.15 Hz) and high-frequency (HF) (0.15-0.4 Hz) components.

Results: In the bradycardic group, both LF and HF increased after massive hemorrhage, but during progressive hemorrhagic shock these components decreased while HR increased. In the tachycardic group, LF increased after massive hemorrhage, but during progressive hemorrhagic shock LF decreased with continuous suppression of HF.

Conclusion: Massive hemorrhage caused two types of HR response: bradycardia and tachycardia. The HRV profile showed differential autonomic characteristics, and could be a valuable tool in assessing various degrees of hemorrhagic shock.

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