title: Direct peritoneal resuscitation improves inflammation, liver blood flow, and pulmonary edema in a rat model of acute brain death.
abstract: BACKGROUND
  Brain death in organ donors alters central hemodynamic performance, impairs physiology, exaggerates inflammation, and causes end-organ microcirculatory dysfunction and hypoxia. A new treatment, direct peritoneal resuscitation (DPR), might improve these derangements in acute brain death (ABD).
  
  
  METHODS
  We studied a standardized rodent model of brain death with matched controls to assess the efficacy of DPR as a resuscitation strategy after ABD. Anesthetized Sprague-Dawley rats were randomized as follows: ABD (supradural balloon inflation) with minimal IV fluid (IVF; 2 mL/h, n = 12); ABD + adequate IVF (5 mL/h, n = 12); ABD with aggressive IVF (goal: mean arterial pressure [MAP] >80 mmHg, n = 15); or ABD + IVF + DPR (goal: MAP >80 mmHg, n = 12). Ventilation support, IVF, and DPR were started at loss of reflexes, and MAP, heart rate, and effective hepatic blood flow were recorded.
  
  
  RESULTS
  High IVF and DPR prevented mortality (0%) compared with low IVF (81.8%) or mid IVF (16.7%). Effective hepatic blood flow was decreased in low and mid IVF (2.8 ± 0.3 mL/min/g body weight and 4.0 ± 0.5 mL/min/g body weight, respectively) vs baseline, but was stable in high IVF (6.2 ± 0.5 mL/min/g body weight; NS) or improved with DPR (8.6 ± 0.7 mL/min/g body weight). The high-IVF group had significant organ edema, which was prevented in the DPR group. The mid-IVF and low-IVF groups had higher serum markers of organ injury compared with high-IVF or DPR groups. The high-IVF group had elevated inflammatory cytokines compared with the DPR group.
  
  
  CONCLUSIONS
  Direct peritoneal resuscitation improved survival and effective hepatic blood flow, required less IVF to stabilize blood pressure, prevented organ edema, and normalized fluid electrolyte balance compared with IVF-alone groups. Direct peritoneal resuscitation in animals reduced inflammatory response after ABD compared with IVF-alone controls. These data suggest a potential role for DPR in organ donors to stabilize donors and possibly increase the number of organs suitable for transplantation per donor.
authors: Department of Surgery, University of Louisville, Louisville, KY; Department of Physiology and Biophysics, University of Louisville, Louisville, KY. Electronic address: jasonw.smith@louisville.edu.
authors: Jason W
authors: JW
authors: Smith
authors: Department of Surgery, University of Louisville, Louisville, KY.
authors: Cameron A
authors: CA
authors: Ghazi
authors: Department of Surgery, University of Louisville, Louisville, KY.
authors: Brandon C
authors: BC
authors: Cain
authors: Department of Physiology and Biophysics, University of Louisville, Louisville, KY; Department of Internal Medicine, Mayo Clinic, Rochester, MN.
authors: Ryan T
authors: RT
authors: Hurt
authors: Department of Surgery, University of Louisville, Louisville, KY; Department of Physiology and Biophysics, University of Louisville, Louisville, KY; Louisville Veterans Affairs Medical Center, Louisville, KY.
authors: R Neal
authors: RN
authors: Garrison
authors: Department of Surgery, University of Louisville, Louisville, KY; Department of Physiology and Biophysics, University of Louisville, Louisville, KY; Louisville Veterans Affairs Medical Center, Louisville, KY.
authors: Paul J
authors: PJ
authors: Matheson
mesh_terms: D000818:Animals; D001926:Brain Death / Q000503:physiopathology*; D004573:Electrolytes / Q000627:therapeutic use*; D005440:Fluid Therapy / Q000379:methods*; D007249:Inflammation / Q000209:etiology / Q000517:prevention & control*; D007274:Injections, Intraperitoneal; D008102:Liver Circulation; D011654:Pulmonary Edema / Q000209:etiology / Q000517:prevention & control*; D011897:Random Allocation; D051381:Rats; D017207:Rats, Sprague-Dawley; D012151:Resuscitation / Q000379:methods*; D009927:Tissue and Organ Procurement
chemical_list: D004573:Electrolytes