Experimental Study of Controlled Fluid Resuscitation in the Treatment of Severe and Uncontrolled Hemorrhagic Shock

Lu, Yuan-Qiang; Cai, Xiujun; Gu, Linhui; Wang, Qi; Huang, Weidong; Bao, De-guo

doi:10.1097/ta.0b013e31815202c9

Cited by 37 publications

(28 citation statements)

References 18 publications

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“…We have recently seen similar changes in adipokines in patients with severe burns [16]. These adipokines have been suggested to play important roles in tissue inflammation; however, a role in critically ill patients has yet to be elucidated [51-53]. In the present study, reduced adipokine levels were observed in the presence of injury rather than disuse, suggesting a greater influence of the injury component.…”

Section: Discussionsupporting

confidence: 74%

Severe burn and disuse in the rat independently adversely impact body composition and adipokines

Wade

Baer

et al. 2013

Crit Care

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IntroductionSevere trauma is accompanied by a period of hypermetabolism and disuse. In this study, a rat model was used to determine the effects of burn and disuse independently and in combination on body composition, food intake and adipokines.MethodsMale rats were assigned to four groups 1) sham ambulatory (SA), 2) sham hindlimb unloaded (SH), 3) 40% total body surface area full thickness scald burn ambulatory (BA) and 4) burn and hindlimb unloaded (BH). Animals designated to the SH and BH groups were placed in a tail traction system and their hindlimbs unloaded. Animals were followed for 14 days. Plasma, urine, fecal and tissue samples were analyzed.ResultsSA had a progressive increase in body mass (BM), SH and BA no change and BH a reduction. Compared to SA, BM was reduced by 10% in both SH and BA and by 17% when combined in BH. Compared to SA, all groups had reductions in lean and fat body mass with BH being greater. The decrease in lean mass was associated with the rate of urinary corticosterone excretion. The loss in fat mass was associated with decreases in plasma leptin and adiponectin and an increase in ghrelin. Following the acute response to injury, BH had a greater food intake per 100 g BM. Food intake was associated with the levels of leptin, adiponectin and ghrelin.ConclusionsThe effects of the combination of burn and disuse in this animal model were additive, therefore in assessing metabolic changes with severe trauma both injury and disuse should be considered. Furthermore, the observed changes in adipokines, corticosterone and ghrelin provide insights for interventions to attenuate the hypermetabolic state following injury, possibly reducing catabolism and muscle loss and subsequent adverse effects on recovery and function.

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Section: Discussionsupporting

confidence: 74%

Severe burn and disuse in the rat independently adversely impact body composition and adipokines

Wade

Baer

et al. 2013

Crit Care

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“…All the rats suffered approximately 50% blood loss based on their body weight and survived in all the above-mentioned three phases. These results are consistent with our previous studies which reported that rats could survive acute blood loss to 50% 2007a;2007b). Fig.1 shows MAP changes of the rats in the three groups.…”

Section: Characteristics Of the Animal Modelsupporting

confidence: 82%

Hypertonic saline resuscitation reduces apoptosis of intestinal mucosa in a rat model of hemorrhagic shock

Huang

Cai

et al. 2008

J. Zhejiang Univ. Sci. B

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Abstract:Objective: To investigate the early effects of hypertonic and isotonic saline solutions on apoptosis of intestinal mucosa in rats with hemorrhagic shock. Methods: A model of rat with severe hemorrhagic shock was established in 21 Sprague-Dawley (SD) rats. The rats were randomly divided into the sham group, normal saline resuscitation (NS) group, and hypertonic saline resuscitation (HTS) group, with 7 in each group. We detected and compared the apoptosis in small intestinal mucosa of rats after hemorrhagic shock and resuscitation by terminal deoxynucleotidyl transferase dUTP nick end labelling (TUNEL), FITC (fluorescein-iso-thiocyanate)-Annexin V/PI (propidium iodide) double staining method, and flow cytometry. Results: In the early stage of hemorrhagic shock and resuscitation, marked apoptosis of small intestinal mucosa in the rats of both NS and HTS groups was observed. The numbers of apoptotic cells in these two groups were significantly greater than that in the sham group (P<0.01). In the HTS group, the apoptic cells significantly decreased, compared with the NS group (P<0.01). Conclusion: In this rat model of severe hemorrhagic shock, the HTS resuscitation of small volume is more effective than the NS resuscitation in reducing apoptosis of intestinal mucosa in rats, which may improve the prognosis of trauma.

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“…Volume expansion with crystalloid (hypertonic saline, ringer's lactate, normal saline) or synthetic colloid solutions play an even more important role in bleeding patients when blood products are not an option. Hypotensive resuscitation of these patients should also be considered until definitive control of the bleeding is achieved [8,9]. Acute normovolemic hemodilution may prove to be a valuable means by which to reduce intraoperative blood loss [10,11], provided an adequate beginning Hb level is present for the effective employment of this technique.…”

Section: Discussionmentioning

confidence: 99%

Optimizing Outcomes in the Jehovah’s Witness Following Trauma: Special Management Concerns for a Unique Population

Georgiou¹,

Inaba

DuBose³

et al. 2009

Eur J Trauma Emerg Surg

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Although our experience was limited, we found no significant difference in the mortality or morbidity between JW patients who received or abstained from transfusion following major trauma. We should keep in mind that the population was small, in order to extract safe conclusions regarding whether we should transfuse or not transfuse trauma patients. We can, however, see interesting insights on the value of trauma resuscitation.

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Experimental Study of Controlled Fluid Resuscitation in the Treatment of Severe and Uncontrolled Hemorrhagic Shock

Cited by 37 publications

References 18 publications

Severe burn and disuse in the rat independently adversely impact body composition and adipokines

Severe burn and disuse in the rat independently adversely impact body composition and adipokines

Hypertonic saline resuscitation reduces apoptosis of intestinal mucosa in a rat model of hemorrhagic shock

Optimizing Outcomes in the Jehovah’s Witness Following Trauma: Special Management Concerns for a Unique Population

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