title: Ideal target arterial pressure after control of bleeding in a rabbit model of severe traumatic hemorrhagic shock: results from volume loading-based fluid resuscitation.
abstract: BACKGROUND
  Previously reported ideal target mean arterial pressure (MAP) after control of bleeding in traumatic hemorrhagic shock (THS) requires further verification in more clinically related models. The authors explored this issue via gradient volume loading without vasopressor therapy. As certain volume loading can induce secretion of atrial natriuretic peptide (ANP), which has been shown to be protective, the authors also observed its potential role.
  
  
  METHODS
  Fifty male New Zealand rabbits were submitted to 1.5 h of uncontrolled THS (with another eight rabbits assigned to the sham group). After bleeding control, treated rabbits were randomly (n = 10, respectively) resuscitated with blood and Ringer lactate (1:2) to achieve target MAP of 50, 60, 70, 80, and 90 mm Hg within 1 h. During the following 2 h, they were resuscitated toward baseline MAP. Rabbits were observed until 7 h.
  
  
  RESULTS
  After resuscitation, infused fluid was lower and oxidative stress injury was milder in the 70 mm Hg group. Fluid volume loaded during the initial hour after hemostasis was negatively correlated with pH, oxygen saturation, and base excess at the end of resuscitation. It also correlated positively with proinflammatory responses in bronchoalveolar lavage fluid at 7 h and 7-h mortality. Moreover, after volume loading, the 80 mm Hg group showed significantly increased serum ANP level, which correlated with the expression of Akt protein in the jejunum at 7 h.
  
  
  CONCLUSIONS
  In rabbits the ideal target MAP during the initial resuscitation of severe THS after hemostasis was 70 mm Hg. ANP may have a critical role in gut protection.
authors: Department of Emergency Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, P. R. China; Research Institute of Emergency Medicine, Zhejiang University, Hangzhou, P. R. China.
authors: Xiao-Gang
authors: XG
authors: Zhao
authors: Department of Emergency Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, P. R. China; Research Institute of Emergency Medicine, Zhejiang University, Hangzhou, P. R. China.
authors: Shou-Yin
authors: SY
authors: Jiang
authors: Department of Emergency Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, P. R. China; Research Institute of Emergency Medicine, Zhejiang University, Hangzhou, P. R. China.
authors: Mao
authors: M
authors: Zhang
authors: Department of Emergency Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, P. R. China; Research Institute of Emergency Medicine, Zhejiang University, Hangzhou, P. R. China.
authors: Guang-Ju
authors: GJ
authors: Zhou
authors: Department of Emergency Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, P. R. China; Research Institute of Emergency Medicine, Zhejiang University, Hangzhou, P. R. China.
authors: Ying-Ying
authors: YY
authors: Zhao
authors: Department of Emergency Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, P. R. China; Research Institute of Emergency Medicine, Zhejiang University, Hangzhou, P. R. China.
authors: Hui-Xing
authors: HX
authors: Yi
authors: Department of Emergency Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, P. R. China; Research Institute of Emergency Medicine, Zhejiang University, Hangzhou, P. R. China.
authors: Li-Bing
authors: LB
authors: Jiang
authors: Department of Emergency Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, P. R. China; Research Institute of Emergency Medicine, Zhejiang University, Hangzhou, P. R. China. Electronic address: z2emergent@gmail.com.
authors: Jian-An
authors: JA
authors: Wang
mesh_terms: D000818:Animals; D009320:Atrial Natriuretic Factor / Q000097:blood*; D001794:Blood Pressure; D001992:Bronchoalveolar Lavage Fluid / Q000737:chemistry; D016207:Cytokines / Q000032:analysis; D004487:Edema / Q000517:prevention & control; D005440:Fluid Therapy; D006439:Hemodynamics; D008297:Male; D018384:Oxidative Stress; D051057:Proto-Oncogene Proteins c-akt / Q000378:metabolism; D011817:Rabbits; D011897:Random Allocation; D012151:Resuscitation / Q000379:methods*; D012771:Shock, Hemorrhagic / Q000097:blood / Q000628:therapy*; D014882:Water-Electrolyte Balance
chemical_list: D016207:Cytokines; D009320:Atrial Natriuretic Factor; D051057:Proto-Oncogene Proteins c-akt
keywords: Atrial natriuretic peptide; Fluid resuscitation; Hemorrhagic shock; Inflammation; Volume overload