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doi: 10.1097/ALN.0000000000000011
Critical Care Medicine: Basic Science

Diaphragmatic Function Is Preserved during Severe Hemorrhagic Shock in the Rat

Carreira, Serge M.D.; Lê Dinh, Matthieu M.Sc.; Soubeyrand, Marc M.D.; Poloujadoff, Marie-Pierre M.D., Ph.D.; Riou, Bruno M.D., Ph.D.; Similowski, Thomas M.D., Ph.D.; Coirault, Catherine M.D., Ph.D.; Demoule, Alexandre M.D., Ph.D.

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Background: Acute diaphragmatic dysfunction has been reported in septic and cardiogenic shock, but few data are available concerning the effect of hemorrhagic shock on diaphragmatic function. The authors examined the impact of a hemorrhagic shock on the diaphragm.
Methods: Four parallel groups of adult rats were submitted to hemorrhagic shock induced by controlled exsanguination targeting a mean arterial blood pressure of 30 mmHg for 1 h, followed by a 1-h fluid resuscitation with either saline or shed blood targeting a mean arterial blood pressure of 80 mmHg. Diaphragm and soleus strip contractility was measured in vitro. Blood flow in the muscle microcirculation was measured in vivo using a Laser Doppler technique. Muscle proinflammatory cytokine concentrations were also measured.
Results: Hemorrhagic shock was characterized by a decrease in mean arterial blood pressure to 34 ± 5 mmHg (−77 ± 4%; P< 0.05) and high plasma lactate levels (7.6 ± 0.9 mM; P < 0.05). Although tetanic tension of the diaphragm was not altered, hemorrhagic shock induced dramatic impairment of tetanic tension of the soleus (−40 ± 19%; P < 0.01), whereas proinflammatory cytokine levels were low and not different between the two muscles. Resuscitation with either blood or saline did not further modify either diaphragm or soleus performance and proinflammatory cytokine levels. The shock-induced decrease in blood flow was much more pronounced in the soleus than in the diaphragm (−75 ± 13% vs. −17 ± 10%; P = 0.02), and a significant interaction was observed between shock and muscle (P < 0.001).
Conclusion: Diaphragm performance is preserved during hemorrhagic shock, whereas soleus performance is impaired, with no further impact of either blood or saline fluid resuscitation.

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