Efficiency of small-volume resuscitation in restoration of disturbed skeletal muscle microcirculation after soft-tissue trauma and haemorrhagic shock.
OBJECTIVE
Despite advances in primary care, trauma in conjunction with shock remains the leading cause for morbidity and mortality of young adults in western countries. Herein, we report on the efficiency of small-volume resuscitation to improve compromised perfusion of traumatised skeletal muscle tissue in shock.


METHODS
In pentobarbital anaesthetised, mechanically ventilated rats, closed soft-tissue trauma of the right hind limb was induced, followed by induction of haemorrhagic shock [mean arterial blood pressure (MAP) 40 mmHg for 1 h]. For resuscitation, animals received saline (four-times the shed blood volume/20 min), 10% hydroxyethyl starch (HES) 200/0.5 (equal to shed blood volume/5 min) or 7.2% sodium chloride/6% hydroxyethyl starch 200/0.5 (HyperHES; 10% of shed blood volume/2 min). At 2 h of resuscitation, traumatised skeletal muscle tissue was analysed by in vivo microscopy. Non-resuscitated animals served as shock controls.


RESULTS
Despite incomplete restoration of systemic blood pressure, HyperHES was superior to saline, but not to HES, with respect to amelioration of nutritive perfusion. Inflammatory cell response within the traumatised skeletal muscle tissue escaped from the anti-adhesive properties of HyperHES when applied for resuscitation from hypovolaemic shock, and did not differ from values in HES-treated and saline-treated animals.


CONCLUSIONS
Resuscitation with HyperHES is as effective as HES in improving capillary perfusion in traumatised skeletal muscle during haemorrhagic shock. However, because values of functional capillary density in the HyperHES-treated and HES-treated animals were still markedly below those reported in traumatised skeletal muscle of normovolaemic animals, further tools are needed to enhance efficiency in treatment of local skeletal muscle tissue injury during haemorrhagic shock.
Gierer
Philip
P
Department of Trauma and Reconstructive Surgery, University of Rostock, Schillingallee 35, 18057 Rostock, Germany. philip.gierer@med.uni-rostock.de
Vollmar
Brigitte
B
Schaser
Klaus-Dieter
KD
Andreas
Christian
C
Gradl
Georg
G
Mittlmeier
Thomas
T
D000818:Animals; D002196:Capillaries / Q000502:physiology; D004195:Disease Models, Animal; D004338:Drug Combinations; D006439:Hemodynamics; D006895:Hydroxyethyl Starch Derivatives / Q000627:therapeutic use*; D008297:Male; D008833:Microcirculation; D008856:Microscopy, Fluorescence; D018482:Muscle, Skeletal / Q000098:blood supply*; D010952:Plasma Substitutes / Q000627:therapeutic use*; D051381:Rats; D017207:Rats, Sprague-Dawley; D012151:Resuscitation / Q000379:methods*; D012771:Shock, Hemorrhagic / Q000628:therapy*; D012965:Sodium Chloride / Q000627:therapeutic use; D017695:Soft Tissue Injuries / Q000628:therapy
D004338:Drug Combinations; D006895:Hydroxyethyl Starch Derivatives; D010952:Plasma Substitutes; D012965:Sodium Chloride