Comparison of lung injury after normal or small volume optimized resuscitation in a model of hemorrhagic shock.
OBJECTIVE
To compare lung injury induced by a hemorrhagic shock resuscitated with normal saline or with small volumes of a hypertonic/hyperoncotic solution.


METHODS
Randomized, controlled, laboratory study in an animal research laboratory.


METHODS
Nineteen pigs (43 +/- 4 kg).


METHODS
After anesthesia and mechanical ventilation animals were bled to induce a 2-h deep shock and resuscitated for 2 h using normal saline (NS, 2 ml/kg per minute, n = 7) or the association of 7.2% NaCl with 6% hydroxyethylstarch 200/0.5 (HSHES, 4 ml/kg in 10 min followed by 0.2 ml/kg per minute, n = 7) to reach cardiac index and mixed venous oxygen saturation goals. Lungs were removed 6[Symbol: see text]h after the initiation of hemorrhage. Five animals were used as controls without hemorrhage.


RESULTS
Resuscitation goals were achieved using 90 +/- 17 ml/kg NS or 6.8 +/- 1.9 ml/kg HSHES. Lung injury was noted in both hemorrhage groups but was not influenced by the type of resuscitation. Extravascular lung water was measured at 9.6 +/- 1.8 ml/kg in the NS group, 9.2 +/- 1.6 ml/kg in the HSHES, group and 6.4 +/- 1 m/kg in the control group. The degree of histological alveolar membrane focal thickening and interstitial neutrophil infiltration were significantly more pronounced in the hemorrhage groups with no difference between the two types of fluid loading. Finally, pulmonary levels of IL-8 were higher after hemorrhage regardless of the type of resuscitation.


CONCLUSIONS
When included in an optimized and goal directed resuscitation, the use of normal saline or a small volume of hypertonic/hyperoncotic solution does not result in a different early hemorrhage-induced lung injury.
Roch
Antoine
A
Hôpitaux Sud, Service de Réanimation Médicale, 13274 Marseille Cedex 9, France. Antonine.Roch@mail.ap-hm.fr
Blayac
Dorothée
D
Ramiara
Patrice
P
Chetaille
Bruno
B
Marin
Valérie
V
Michelet
Pierre
P
Lambert
Dominique
D
Papazian
Laurent
L
Auffray
Jean-Pierre
JP
Carpentier
Jean-Pierre
JP
D000818:Animals; D001834:Body Water / Q000378:metabolism; D005260:Female; D006895:Hydroxyethyl Starch Derivatives / Q000008:administration & dosage; D016209:Interleukin-8 / Q000378:metabolism; D008168:Lung / Q000378:metabolism / Q000473:pathology*; D023421:Models, Animal; D009504:Neutrophils / Q000378:metabolism; D010952:Plasma Substitutes / Q000008:administration & dosage; D011897:Random Allocation; D012151:Resuscitation / Q000379:methods*; D012462:Saline Solution, Hypertonic / Q000008:administration & dosage; D012771:Shock, Hemorrhagic / Q000473:pathology* / Q000628:therapy; D012965:Sodium Chloride / Q000008:administration & dosage / Q000032:analysis; D013552:Swine
D006895:Hydroxyethyl Starch Derivatives; D016209:Interleukin-8; D010952:Plasma Substitutes; D012462:Saline Solution, Hypertonic; D012965:Sodium Chloride