Peritoneal resuscitation.
BACKGROUND
After resuscitation from hemorrhagic shock, intestinal microvessels constrict leading to impaired mucosal blood flow. This occurs despite restoration of central hemodynamics. We review studies on the use of peritoneal dialysis fluid as an adjunct treatment in amelioration of this gut hypoperfusion.


METHODS
Using in vivo microscopy of the intestinal microcirculation, the effects of topically applied dextrose-based peritoneal dialysis fluid was measured. In other words, animal experiments, the survival benefits, the morbidity, blood flow distribution, and the postresuscitation inflammatory response to direct peritoneal resuscitation (DPR) were determined.


RESULTS
Simulated DPR caused a dramatic vasodilation compared with a progressive vasoconstriction when used during conventional resuscitation (CR) from hemorrhagic shock. It also reversed established vasoconstriction 2 and 4 hours after CR. In CR animals, there was a 40% mortality compared with 100% survival in DPR animals. DPR resulted in a downregulation of the gut-associated proinflammatory response noted after CR and similarly prevented edema formation.


CONCLUSIONS
DPR enhances organ blood flow to organs incited in the pathogenesis of multiple organ failure and improves survival after severe hemorrhage and CR.
Garrison
R Neal
RN
Department of Surgery, University of Louisville and Veterans Affairs Medical Center, ACB Building, Louisville, KY 40292, USA. rngarr01@louisville.edu
Zakaria
El Rasheid
el R
D000704:Analysis of Variance; D000818:Animals; D015314:Dialysis Solutions / Q000627:therapeutic use; D004195:Disease Models, Animal; D005260:Female; D005500:Follow-Up Studies; D007422:Intestines / Q000098:blood supply; D008297:Male; D008833:Microcirculation / Q000502:physiology; D010530:Peritoneal Dialysis / Q000379:methods*; D010537:Peritoneum / Q000098:blood supply*; D011336:Probability; D051381:Rats; D017207:Rats, Sprague-Dawley; D012151:Resuscitation / Q000379:methods*; D012307:Risk Factors; D012680:Sensitivity and Specificity; D012771:Shock, Hemorrhagic / Q000503:physiopathology / Q000628:therapy*; D013152:Splanchnic Circulation / Q000502:physiology*; D015996:Survival Rate; D016896:Treatment Outcome
D015314:Dialysis Solutions