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J Trauma Acute Care Surg. 2018 Feb 14. doi: 10.1097/TA.0000000000001837. [Epub ahead of print]

Measurement of Compensatory Reserve Predicts Racial Differences in Tolerance to Simulated Hemorrhage in Women.

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Department of Kinesiology and Applied Physiology, University of Delaware, Newark, DE.
Department of Family Medicine, University of North Carolina School of Medicine, Chapel Hill, NC.
US Army Institute of Surgical Research, JBSA Fort Sam, Houston, TX.
The John B. Pierce Laboratory, Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, Yale School of Public Health, New Haven, CT.



The measurement of Compensatory Reserve (CRM) has been established to accurately measure the body's total integrated capacity to compensate for physiological states of reduced central blood volume, and predict hemodynamic decompensation associated with inadequate tissue oxygenation. We previously demonstrated that African American (AA) women have a higher tolerance to reductions in central blood volume. Therefore, we tested the hypothesis that the CRM would identify racial differences during simulated hemorrhage, prior to the onset of traditional signs/symptoms.


We performed a retrospective analysis during simulated hemorrhage using lower body negative pressure in 23 AA (22 ± 1years; 24 ± 1kg/m) and 31 white women (WW; 20 ± 1years; 23 ± 1kg/m). Beat-by-beat blood pressure (BP) and heart rate (HR) were recording during progressive lower body negative pressure to presyncope. BP waveforms were analyzed using a machine-learning algorithm to derive the CRM at each lower body negative pressure stage.


Resting mean arterial BP (AA, 78 ± 3 vs. WW, 74 ± 2mmHg) and HR (AA, 68 ± 2 vs. WW, 65 ± 2bpm) were similar between groups. The CRM progressively decreased during LBNP in both groups, however the rate of decline in the CRM was less (P<0.05) in AA. The CRM was 4% higher in AA at -15mmHg lower body negative pressure and progressively increased to 21% higher at -50mmHg lower body negative pressure (P<0.05). However changes in BP and HR were not different between groups.


These data support the notion that the greater tolerance to simulated hemorrhage induced by lower body negative pressure in AA women can be explained by their greater capacity to protect the reserve to compensate for progressive central hypovolemia compared to WW independent of standard vital signs.


2 STUDY TYPE: Diagnostic test.

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