Online Supplemental Material for Sympathetic Vasomotion as an Early Marker of Hemorrhage

Online supplement for manuscript submission entitled, "Sympathetic vasomotion as an early marker of hemorrhage." ABSTRACT Each year, over 1.8 million people die from hemorrhagic shock, and the median time from onset to death is only two hours, making early recognition and prompt action the cornerstone of management. The sympathetic nervous system is the fastest physiological hemodynamic compensatory mechanism, and we have developed a novel measure of sympathetic vascular control called sympathetic vasomotion which could serve as an early marker of hemorrhage. We performed unilateral renal denervation on six rabbits and instrumented these rabbits with bilateral renal flow probes and arterial pressure telemeters to allow for measurement of sympathetic vasomotion. After a two-week recovery period, the rabbits then underwent controlled blood withdrawal via an auricular arterial catheter to simulate hemorrhage. Differences between innervated and denervated kidneys in admittance gain, phase shift, and coherence increased significantly prior to increases in heart rate or decreases in blood pressure. These data suggest that sympathetic vasomotion may be useful as a physiologically based biomarker in the detection of early hemorrhage. Further studies are needed to evaluate the utility of sympathetic nervous system monitoring in clinical contexts.