title: Fluid resuscitation increases inflammatory gene transcription after traumatic injury.
abstract: BACKGROUND
  The debate continues over type and quantity of fluid to administer for resuscitation after traumatic injury. This study aimed to examine effects of resuscitation with lactated Ringer's (LR) and Hextend (HEX) on the inflammatory response after uncontrolled hemorrhagic shock (UHS).
  
  
  METHODS
  There were 38 swine randomized. Control swine were anesthetized and killed. Sham swine underwent laparotomy, splenectomy, and 2 hours of anesthesia. UHS swine received a grade V liver injury after laparotomy and splenectomy and were randomized to no fluid (NF) resuscitation or to blinded resuscitation 30 minutes after injury with LR or HEX. Fluids were infused as needed to maintain baseline blood pressure for 90 minutes. Lung tissue mRNA levels of interleukin-6 (IL-6), granulocyte colony stimulating factor (G-CSF), and tumor necrosis factor alpha (TNF-alpha) were determined. Lung sections were examined for neutrophils (PMNs) sequestered within alveolar walls.
  
  
  RESULTS
  All UHS animals survived and initial blood loss was similar between groups. Mean arterial pressures (MAPs) were similar for all UHS animals until resuscitation was initiated. MAPs of resuscitated animals remained similar and were significantly higher than MAPs of the NF animals. Sequestered PMNs were equally elevated in all UHS animals. Cytokine analysis showed increased IL-6, G-CSF, and TNF-alpha gene transcription in resuscitated swine compared with NF swine. LR and HEX resuscitated swine tissue mRNA levels showed no differences.
  
  
  CONCLUSIONS
  Fluid resuscitation after solid organ injury and uncontrolled hemorrhage results in greater proinflammatory gene transcription than no resuscitation. LR and HEX resuscitation have equivalent effects on indices of inflammation in the lungs.
authors.affiliation: Oregon Health & Science University, Portland, Oregon, USA. wattersj@ohsu.edu
authors.forename: Jennifer M
authors.initials: JM
authors.lastname: Watters
authors.forename: Brandon H
authors.initials: BH
authors.lastname: Tieu
authors.forename: S Rob
authors.initials: SR
authors.lastname: Todd
authors.forename: Terisa
authors.initials: T
authors.lastname: Jackson
authors.forename: Patrick J
authors.initials: PJ
authors.lastname: Muller
authors.forename: Darren
authors.initials: D
authors.lastname: Malinoski
authors.forename: Martin A
authors.initials: MA
authors.lastname: Schreiber
mesh_terms: D000818:Animals; D003102:Colloids / Q000494:pharmacology*; D000077324:Crystalloid Solutions; D016207:Cytokines / Q000378:metabolism; D004311:Double-Blind Method; D005440:Fluid Therapy / Q000009:adverse effects*; D006895:Hydroxyethyl Starch Derivatives / Q000494:pharmacology; D007249:Inflammation; D007552:Isotonic Solutions / Q000494:pharmacology*; D008168:Lung / Q000276:immunology; D018375:Neutrophil Activation / Q000187:drug effects; D010952:Plasma Substitutes / Q000494:pharmacology; D011897:Random Allocation; D000077325:Ringer's Lactate; D012771:Shock, Hemorrhagic / Q000276:immunology / Q000628:therapy*; D013552:Swine; D014158:Transcription, Genetic / Q000187:drug effects
chemical_list: D003102:Colloids; D000077324:Crystalloid Solutions; D016207:Cytokines; D006895:Hydroxyethyl Starch Derivatives; D007552:Isotonic Solutions; D010952:Plasma Substitutes; D000077325:Ringer's Lactate