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

Abstract

Hemorrhagic shock and resuscitation increased lymph flow by altering capillary water transport and expanding interstitial volume. Increased lymph hyaluronic acid and inflammatory cytokines with traditional resuscitation were modulated to sham levels by DPR. In addition, DPR reduces these patterns presumably via an osmotic effect on capillary water transport. Adjunctive DPR might offer novel protection from systemic inflammatory response syndrome after hemorrhagic shock and resuscitation.

A novel mechanism for neutrophil priming in trauma: Potential role of peritoneal fluid

“…A major component of mesenteric lymph that is common to peritoneal fluid is interstitial compartment fluid which is believed to be the major harbinger of pro-inflammatory gut derived mediators after hemorrhagic shock and/or ischemia/reperfusion injury. (14, 15) We therefore extrapolated from that information to hypothesize that peritoneal fluid may have a similar effect on PMN’s as has been demonstrated with mesenteric lymph.…”

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."…”

Intra-Abdominal Hypertension and Abdominal Compartment Syndrome in Association with Ruptured Abdominal Aortic Aneurysm in the Endovascular Era: Vigilance Remains Critical

“…Using this protocol, they achieved earlier definitive fascial closure as compared to standard management, that is, 4.35 ± 1.6 versus 7.05 ± 3.31 days, P < 0.003, respectively. The same team has presented data from animal models demonstrating favorable modulation of the inflammatory cascade by this technique [37]. The utility and risk associated with this management technique in the setting of rAAA has yet to be defined but holds promise.…”