Resuscitation with lactated ringer's does not increase inflammatory response in a Swine model of uncontrolled hemorrhagic shock.
Lactated Ringer's (LR) and normal saline (NS) are widely and interchangeably used for resuscitation of trauma victims. Studies show LR to be superior to NS in the physiologic response to resuscitation. Recent in vitro studies demonstrate equivalent effects of LR and NS on leukocytes. We aimed to determine whether LR resuscitation would produce an equivalent inflammatory response compared with normal saline (NS) resuscitation in a clinically relevant swine model of uncontrolled hemorrhagic shock. Thirty-two swine were randomized. Control animals (n = 6) were sacrificed following induction of anesthesia for baseline data. Sham animals (n = 6) underwent laparotomy and 2 h of anesthesia. Uncontrolled hemorrhagic shock animals (n = 10/group) underwent laparotomy, grade V liver injury, and blinded resuscitation with LR or NS to maintain baseline blood pressure for 1.5 h before sacrifice. Lung was harvested, and tissue mRNA levels of interleukin-6 (IL-6), granulocyte colony-stimulating factor (G-CSF), and tumor necrosis factor-alpha (TNF-alpha) were determined using quantitative reverse transcriptase polymerase chain reaction (Q-RT-PCR). Sections of lung were processed and examined for neutrophils sequestered within the alveolar walls. Cytokine analysis showed no difference in IL-6 gene transcription in any group (P = 0.99). Resuscitated swine had elevated G-CSF and TNF-alpha gene transcription, but LR and NS groups were not different from each other (P= 0.96 and 0.10, respectively). Both resuscitation groups had significantly more alveolar neutrophils present than controls (P < 0.01) and shams (P < 0.05) but were not different from one another (P= 0.83). LR and NS resuscitation have equivalent effects on indices of inflammation in the lungs in our model of uncontrolled hemorrhagic shock.
Watters
Jennifer M
JM
Department of Surgery, Oregon Health and Science University, Portland, Oregon 97239, USA. wattersj@ohsu.edu
Brundage
Susan I
SI
Todd
S Rob
SR
Zautke
Nathan A
NA
Stefater
J A
JA
Lam
J C
JC
Muller
Patrick J
PJ
Malinoski
Darren
D
Schreiber
Martin A
MA
D000818:Animals; D001794:Blood Pressure; D004195:Disease Models, Animal; D004231:Diuresis; D016179:Granulocyte Colony-Stimulating Factor / Q000235:genetics; D007249:Inflammation / Q000276:immunology / Q000473:pathology / Q000503:physiopathology*; D015850:Interleukin-6 / Q000235:genetics; D007552:Isotonic Solutions / Q000627:therapeutic use*; D012151:Resuscitation / Q000379:methods*; D020133:Reverse Transcriptase Polymerase Chain Reaction; D000077325:Ringer's Lactate; D012771:Shock, Hemorrhagic / Q000473:pathology / Q000503:physiopathology* / Q000628:therapy / Q000652:urine; D012965:Sodium Chloride / Q000627:therapeutic use; D013552:Swine; D014409:Tumor Necrosis Factor-alpha / Q000235:genetics
D015850:Interleukin-6; D007552:Isotonic Solutions; D000077325:Ringer's Lactate; D014409:Tumor Necrosis Factor-alpha; D016179:Granulocyte Colony-Stimulating Factor; D012965:Sodium Chloride