title: Small volume resuscitation with 3% hypertonic saline solution decrease inflammatory response and attenuates end organ damage after controlled hemorrhagic shock.
abstract: BACKGROUND
  Recently, studies have been conducted examining the efficacy of 3% hypertonic saline solution (HS) for the treatment of traumatic brain injury; however, few studies have analyzed the effects of 3% hemorrhagic shock during hemorrhagic shock. The aim of this study was to test the potential immunomodulatory benefits of 3% hemorrhagic shock resuscitation over standard fluid resuscitation.
  
  
  METHODS
  Wistar rats were bled to a mean arterial pressure of 35 mm Hg and then randomized into 3 groups: those treated with lactated Ringer's solution (LR; 33 mL/kg, n = 7), 3% HS (10 mL/kg, n = 7), and 7.5% HS (4 mL/kg, n = 7). Half of the extracted blood was reinfused after fluid resuscitation. Animals that did not undergo shock served as controls (n = 5). Four hours after hemorrhagic shock, blood was collected for the evaluation of tumor necrosis factor-alpha and interleukin-6 by enzyme immunoassay. Lung and intestinal samples were obtained for histopathologic analysis.
  
  
  RESULTS
  Animals in the HS groups had significantly higher mean arterial pressure than those in the LR group 1 hour after treatment. Osmolarity and sodium levels were markedly elevated in the HS groups. Tumor necrosis factor-alpha and interleukin-6 levels were similar between the control and HS groups but significantly higher in the LR group (P < .05). The lung injury score was significantly higher in the LR group compared with the 7.5% HS and 3% HS groups (5.7 +/- 0.7, 2.1 +/- 0.4, and 2.7 +/- 0.5, respectively). Intestinal injury was attenuated in the 7.5% HS and 3% HS groups compared with the LR group (2.0 +/- 0.6, 2.3 +/- 0.4, and 5.9 +/- 0.6, respectively).
  
  
  CONCLUSIONS
  A small-volume resuscitation strategy modulates the inflammatory response and decreases end-organ damage after HS. Three percent HS provides immunomodulatory and metabolic effects similar to those observed with conventional concentrations of HS.
authors.affiliation: Research Division, InCor, University of São Paulo, School of Medicine, São Paulo, Brazil.
authors.forename: Rodrigo
authors.initials: R
authors.lastname: Vincenzi
authors.forename: Lourdes A
authors.initials: LA
authors.lastname: Cepeda
authors.forename: William M
authors.initials: WM
authors.lastname: Pirani
authors.forename: Paulina
authors.initials: P
authors.lastname: Sannomyia
authors.forename: Mauricio
authors.initials: M
authors.lastname: Rocha-E-Silva
authors.forename: Ruy J
authors.initials: RJ
authors.lastname: Cruz
mesh_terms: D000818:Animals; D001794:Blood Pressure / Q000187:drug effects; D016207:Cytokines / Q000097:blood; D005440:Fluid Therapy / Q000379:methods*; D006439:Hemodynamics; D055370:Lung Injury / Q000503:physiopathology; D008297:Male; D009994:Osmolar Concentration; D051381:Rats; D017208:Rats, Wistar; D012151:Resuscitation / Q000379:methods*; D012462:Saline Solution, Hypertonic / Q000494:pharmacology*; D012771:Shock, Hemorrhagic / Q000503:physiopathology / Q000628:therapy*; D018709:Statistics, Nonparametric
chemical_list: D016207:Cytokines; D012462:Saline Solution, Hypertonic