Chronic resuscitation after trauma-hemorrhage and acute fluid replacement improves hepatocellular function and cardiac output.
OBJECTIVE
To determine whether prolonged (chronic) resuscitation has any beneficial effects on cardiac output and hepatocellular function after trauma-hemorrhage and acute fluid replacement.


BACKGROUND
Acute fluid resuscitation after trauma-hemorrhage restores but does not maintain the depressed hepatocellular function and cardiac output.


METHODS
Male Sprague-Dawley rats underwent a 5-cm laparotomy (i.e., trauma was induced) and were bled to and maintained at a mean arterial pressure of 40 mmHg until 40% of maximal bleed-out volume was returned in the form of Ringer's lactate (RL). The animals were acutely resuscitated with RL using 4 times the volume of maximum bleed-out over 60 minutes, followed by chronic resuscitation of 0, 5, or 10 mL/kg/hr RL for 20 hours. Hepatocellular function was determined by an in vivo indocyanine green clearance technique. Hepatic microvascular blood flow was assessed by laser Doppler flowmetry. Plasma levels of interleukin-6 (IL-6) were determined by bioassay.


RESULTS
Chronic resuscitation with 5 mL/kg/hr RL, but not with 0 or 10 mL/kg/hr RL, restored cardiac output, hepatocellular function, and hepatic microvascular blood flow at 20 hours after hemorrhage. The regimen above also reduced plasma IL-6 levels.


CONCLUSIONS
Because chronic resuscitation with 5 mL/kg/hr RL after trauma-hemorrhage and acute fluid replacement restored hepatocellular function and hepatic microvascular blood flow and decreased plasma levels of IL-6, we propose that chronic fluid resuscitation in addition to acute fluid replacement should be routinely used in experimental studies of trauma-hemorrhage.
Remmers
D E
DE
Center for Surgical Research, Brown University School of Medicine and Rhode Island Hospital, Providence 02903, USA.
Wang
P
P
Cioffi
W G
WG
Bland
K I
KI
Chaudry
I H
IH
D000818:Animals; D002302:Cardiac Output; D004195:Disease Models, Animal; D005440:Fluid Therapy / Q000379:methods*; D006470:Hemorrhage / Q000209:etiology* / Q000378:metabolism / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D015850:Interleukin-6 / Q000097:blood; D007552:Isotonic Solutions / Q000627:therapeutic use; D017078:Laser-Doppler Flowmetry; D008102:Liver Circulation; D008297:Male; D008833:Microcirculation; D051381:Rats; D017207:Rats, Sprague-Dawley; D012151:Resuscitation / Q000379:methods*; D000077325:Ringer's Lactate; D013997:Time Factors; D014947:Wounds and Injuries / Q000150:complications*
D015850:Interleukin-6; D007552:Isotonic Solutions; D000077325:Ringer's Lactate