Effect of different resuscitation strategies on neutrophil activation in a swine model of hemorrhagic shock

• Published in: Resuscitation 2004, Vol.60 (1), p.91-99
• Main Authors: Alam, Hasan B, Stanton, Kathleen, Koustova, Elena, Burris, David, Rich, Norman, Rhee, Peter
• Format: Article
• Language: English
• Subjects: Albumin; Albumina; Albumins - administration & dosage; Albumins - therapeutic use; Albúmina; Analysis of Variance; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Animals; Biological and medical sciences; Blood; Blood Pressure - physiology; Blood Transfusion; Cascada oxidativa; Choque hemorrágico; Colloids; Coloides; Colóides; Cristaloides; Cristalóides; Crystalloids; Dextran; Dextrano; Dextrans - administration & dosage; Dextrans - therapeutic use; Disease Models, Animal; Female; Fluidos de resucitación; Fluidos para resuscitação; Hemoglobins - analysis; Hemorrhagic shock; Hespan; Hipertónico; Hydroxyethyl Starch Derivatives - administration & dosage; Hydroxyethyl Starch Derivatives - therapeutic use; Hypertonic; Intensive care medicine; Isotonic Solutions - administration & dosage; Isotonic Solutions - therapeutic use; Lactated Ringer's; Lactato de Ringer; Lactato Ringer; Medical sciences; Neutrophil Activation - physiology; Neutrophils; Neutrophils - physiology; Neutrófilos; Oxidative burst; Plasma Substitutes - administration & dosage; Plasma Substitutes - therapeutic use; Respiratory Burst - physiology; Resuscitation - methods; Resuscitation fluids; Saline Solution, Hypertonic - administration & dosage; Saline Solution, Hypertonic - therapeutic use; Sangre; Sangue; Shock hemorrágico; Shock, Hemorrhagic - blood; Shock, Hemorrhagic - therapy; Surto oxitadivo; Swine
• ISSN: 0300-9572; 1873-1570
• DOI: 10.1016/j.resuscitation.2003.08.006

Activated neutrophils play a pivotal role in resuscitation injury. The strategies used for resuscitation (types of fluids and methods of administration) can affect the degree of neutrophil activation. The aim of this study was to test the commonly available resuscitation fluids in a large animal model of hemorrhagic shock to determine the strategy associated with the least degree of neutrophil activation. Methods: Female swine (n=63, weight 45–60 kg) were anesthetized using isoflurane and catheters were placed for hemodynamic monitoring. After 120 min, they were subjected to a volume controlled hemorrhage (28 ml/kg) over 15 min, kept in shock for 60 min, and then resuscitated. The resuscitation groups were as follows: (1) anesthesia only (n=5); (2) hemorrhage, sham resuscitation (n=5); (3) LR-fast rate 3× blood loss (n=6); (4) LR slow rate-3× blood loss (n=6); (5) LR low volume-1× blood loss (n=6); (6) Dextran 40-1× blood loss (n=6); (7) 6% hetastarch-1× blood loss (n=6); (8) 5% albumin-1× blood loss (n=6); (9) 25% albumin-1/5× blood loss (n=6); (10) whole blood resuscitation-1× blood loss (n=6); (11) 7.5% hypertonic saline (HTS)-0.3× blood loss (n=5). Resuscitation fluids were infused over 1 h in all groups except group 4 (LR slow rate, which was over 3 h). Animals were observed for 180 min following the resuscitation period. Neutrophil oxidative burst activity was determined in whole blood using flow cytometery. Results: Animals resuscitated with dextran and hetastarch showed significantly ( P