Human neutrophil activation and increased adhesion by various resuscitation fluids.
OBJECTIVE
To determine whether activated neutrophils play a major role in secondary tissue injury after resuscitation in trauma. We hypothesized that human neutrophil activation and adhesion vary, depending on the type and amount of resuscitation fluid used.


METHODS
University-based research facility.


METHODS
Ten healthy adult volunteers.


METHODS
Whole blood from volunteers was serially diluted in polypropylene tubes with various resuscitation fluids. Fluids tested were phosphate-buffered saline, normal saline, lactated Ringer's solution, dextran, hespan, 5% human albumin, 25% human albumin, 3.5% hypertonic saline, and 7.5% hypertonic saline. Neutrophil activation (intracellular oxidative burst activity with dichlorofluorescin diacetate staining) and adhesion (integrin cell surface expression of CD18) were measured with flow cytometry (fluorescence-activated cell sorting). Blood was diluted with hypertonic saline by controlling for sodium content equal to normal saline. dose-related increase in neutrophil oxidative burst activity as the result of dilution followed with crystalloid fluids and artificial colloids (dextran and hespan). The increase was 12-18 x baseline at the 75% dilution. The increase with 5% human albumin was only 2.2 x baseline, and 25% albumin did not demonstrate any increased intracellular activity. A similar significant increase in the neutrophil adhesion expression (CD18) occurred with artificial colloids (p<.05) and, to a lesser extent, with crystalloids, but not with albumin. Hypertonic saline caused a decrease in CD18 cell surface expression.


CONCLUSIONS
This study suggests that the neutrophil activation and adhesion may vary, depending on the type of resuscitative fluid used. All artificial resuscitative fluids may not be similar or innocuous, as demonstrated by the dose-related increase in neutrophil activation and adhesion.
Rhee
P
P
Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA. prhee@usuhs.mil
Wang
D
D
Ruff
P
P
Austin
B
B
DeBraux
S
S
Wolcott
K
K
Burris
D
D
Ling
G
G
Sun
L
L
D000328:Adult; D000418:Albumins; D018821:CD18 Antigens / Q000378:metabolism; D002448:Cell Adhesion / Q000187:drug effects; D003422:Critical Care / Q000592:standards*; D003911:Dextrans; D004305:Dose-Response Relationship, Drug; D005260:Female; D005434:Flow Cytometry; D006801:Humans; D006863:Hydrogen-Ion Concentration; D006895:Hydroxyethyl Starch Derivatives; D007249:Inflammation; D008297:Male; D008875:Middle Aged; D018375:Neutrophil Activation / Q000187:drug effects / Q000502:physiology*; D009994:Osmolar Concentration; D010952:Plasma Substitutes / Q000494:pharmacology*; D012016:Reference Values; D016897:Respiratory Burst / Q000187:drug effects; D012151:Resuscitation; D012462:Saline Solution, Hypertonic; D014947:Wounds and Injuries / Q000097:blood / Q000276:immunology / Q000628:therapy*
D000418:Albumins; D018821:CD18 Antigens; D003911:Dextrans; D006895:Hydroxyethyl Starch Derivatives; D010952:Plasma Substitutes; D012462:Saline Solution, Hypertonic