Hemorrhagic Shock and Resuscitation-Mediated Tissue Water Distribution is Normalized by Adjunctive Peritoneal Resuscitation

Abstract

BACKGROUND-Adjunctive direct peritoneal resuscitation (DPR) from hemorrhagic shock (HS) improves intestinal blood flow and abrogates postresuscitation edema. HS causes water shifts as a result of sodium redistribution and changes in transcapillary Starling forces. Conventional resuscitation (CR) with crystalloid aggravates water sequestration. We examined the compartment pattern of organ tissue water after HS and CR, and modulation of tissue edema by adjunctive DPR.

Preliminary resuscitation for perforated necrotizing enterocolitis: 2 cases treated with initial direct peritoneal resuscitation

“…The benefits reported in this animal modelbased research included instantaneous and sustained increases in mesenteric microvascular perfusion (arterioles and capillaries alike) [4,5]. In addition, they demonstrate restoration of premucosal A3 arteriolar endothelial cell receptor-dependent dilator function [4], avoidance of endothelial cellular edema [4] and tissue edema [6], decreases in resuscitation gut lymph flow and gut lymph concentrations of inflammatory cytokines and hyaluronic acid (a structural glycoprotein involved in regulation of tissue hydration) [7], and decreases in rat mortality [8]. They call this technique "direct peritoneal resuscitation" and have done considerable work toward delineating the vascular response mechanisms involved.…”

“…Over the past decade, Garrison and colleagues have reported local and systemic benefits and the mechanisms involved after the serosal exposure of the intestines to 2.5% dextrose clinical dialysis solution (Delflex, Fresenius Medical Care, Walthum, MA, USA) used as adjunctive treatment with conventional resuscitation after hemorrhagic shock [4][5][6][7][8][9]. The benefits reported in this animal modelbased research included instantaneous and sustained increases in mesenteric microvascular perfusion (arterioles and capillaries alike) [4,5].…”

“…We present observations from 2 cases of perforated NEC resuscitated by repeated pre-and postoperative intraperitoneal infusions of 2.5% dextrose solution. We discuss our observations and the recent research reports using a similar 2.5% dextrose infusion in an animal model of hemorrhagic shock [4][5][6][7][8][9]. We believe we witnessed 2 examples of benefit outside the hemorrhagic shock arena of the technique called "direct peritoneal resuscitation.…”

Multiple Organ Dysfunction Syndrome (MODS): Is It Preventable or Inevitable?

“…Previous studies demonstrated that endorgan injury and subsequent MODS result from a cause-effect relationship between three pathophysiologic events, which likely interact in a time-dependent, tissue-specific fashion. First, a persistent and progressive splanchnic vasoconstriction and hypoperfusion leading to relative ischemia/hypoxia [26,27]; Second, a gut-derived systemic inflamematory response generated by the ischemic gut [28]; and third, inevitable fluid shifts at both the cellular level due to ionic-disequilibrium and at the capillary level due to alteration of the trans-capillary Starling forces that govern fluid exchange [29,30].…”

Modulation of Mesenteric Lymph Flow and Composition by Direct Peritoneal Resuscitation From Hemorrhagic Shock

“…This splanchnic and distant organ hyperperfusion was associated with downregulation of the systemic inflammatory response and an increase in survival compared with conventional resuscitation therapies. 16,18 Recent studies [19][20][21] have noted that postresuscitation tissue neutrophils infiltration, which is tissue and time dependent, cellular edema, and capillary perfusion regulated by hydrogen and potassium membrane transport and water compartment distribution are all normalized by DPR with hypertonic peritoneal dialysis fluid.…”