Optimal fluid resuscitation: timing and composition of intravenous fluids.
BACKGROUND
Recent data suggest that the timing of fluid resuscitation and the type of fluid used to treat hemorrhagic shock contribute to the inflammatory response as well as cell death.


METHODS
Rats were bled of 40% of their total blood volume and then resuscitated in either early or delayed fashion. Treatment was assigned randomly and consisted of lactated Ringer's solution, normal saline, bicarbonate Ringer's solution, hypertonic saline, or no resuscitation. The first four groups were subdivided into early and late resuscitation. After a 5-h observation period, lung and liver samples were evaluated for apoptosis, and blood was collected for measurements of the cytokines interleukin (IL)-6, IL-10, and IL-1beta.


RESULTS
The rats that were not resuscitated had significantly more apoptosis in liver tissue. In the lung, bicarbonate Ringer's solution, when given early, was associated with significantly less apoptosis. Non-resuscitated rats had significantly higher IL-6 concentrations than all other groups. Animals receiving hypertonic saline early had significantly higher IL-6 concentrations than those given any other fluid. The concentration of IL-1beta was significantly higher in the non-resuscitated rats than in those receiving bicarbonate Ringer's, lactated Ringer's, or normal saline for early resuscitation. Interleukin-10 was elevated significantly in non-resuscitated rats.


CONCLUSIONS
Cellular destruction and a pro-inflammatory response follow hemorrhagic shock. Early resuscitation with isotonic crystalloid fluids decreases these responses.
Boomer
Laura
L
Department of Surgery, University of Nevada School of Medicine, Las Vegas, Nevada 89102, USA.
Jones
Wright
W
Davis
Brett
B
Williams
Shelley
S
Barber
Annabel
A
D000818:Animals; D017209:Apoptosis; D000077324:Crystalloid Solutions; D005440:Fluid Therapy; D007552:Isotonic Solutions / Q000737:chemistry / Q000627:therapeutic use; D008099:Liver / Q000166:cytology / Q000187:drug effects; D008168:Lung / Q000166:cytology / Q000187:drug effects; D008297:Male; D051381:Rats; D017207:Rats, Sprague-Dawley; D000077325:Ringer's Lactate; D012462:Saline Solution, Hypertonic / Q000737:chemistry / Q000627:therapeutic use; D012771:Shock, Hemorrhagic / Q000628:therapy*; D013997:Time Factors; D016896:Treatment Outcome
D000077324:Crystalloid Solutions; D007552:Isotonic Solutions; D000077325:Ringer's Lactate; D012462:Saline Solution, Hypertonic; C506920:bicarbonated Ringer's solution