Fluid resuscitation increases inflammatory gene transcription after traumatic injury.
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.
Watters
Jennifer M
JM
Oregon Health & Science University, Portland, Oregon, USA. wattersj@ohsu.edu
Tieu
Brandon H
BH
Todd
S Rob
SR
Jackson
Terisa
T
Muller
Patrick J
PJ
Malinoski
Darren
D
Schreiber
Martin A
MA
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
D003102:Colloids; D000077324:Crystalloid Solutions; D016207:Cytokines; D006895:Hydroxyethyl Starch Derivatives; D007552:Isotonic Solutions; D010952:Plasma Substitutes; D000077325:Ringer's Lactate