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Moderate Hypothermia Prevents Brain Stem Oxidative Stress Injury after Hemorrhagic Shock

Guven, Hakan MD; Amanvermez, Ramazan PhD; Malazgirt, Zafer MD, FACS; Kaya, Ekrem MD; Doganay, Zahide MD; Celik, Cemil PhD; Ozkan, Kayhan MD

Journal of Trauma and Acute Care Surgery: July 2002 - Volume 53 - Issue 1 - p 66-72
Original Articles

Background  The purpose of this study was to investigate the effects of temperature on oxidative stress in brain stem tissue induced by hemorrhagic shock. We researched the hemorrhagic oxidative stress at various core temperatures using reduced glutathione (GSH) levels and thiobarbituric acid-reactive substances (TBARS) as markers of lipid peroxidation in brain stem homogenate.

Methods  Forty rats were divided into four groups, of which one constituted the nonbleeding normothermia control group. In all of the three study groups, 40% of estimated blood volume was removed while they were being held at normothermia, mild hypothermia (32°C), or moderate hypothermia (28°C). Parameters including mean arterial pressure, rectal temperature, and heart and breathing rates were monitored and recorded during the procedures. After an hour at shock state, tissue samples were removed by craniectomy.

Results  The tissue levels of TBARS increased significantly in normothermic and mild hypothermic hemorrhagic shock groups (10.74 nmol/g and 8.26 nmol/g) as compared with the control group (3.50 nmol/g) (p < 0.001). However, the tissue TBARS level in the moderate hypothermia group was only minimally increased (4.53 nmol/g). GSH showed a slight decrease in normothermic and mild hypothermic bleeding rats, and were unchanged in the moderate hypothermic rats.

Conclusion  Moderate systemic hypothermia (28°C) appears to protect brain stem tissue from oxidative stress during severe hemorrhagic shock in rats, as indicated by insignificant change in tissue TBARS and GSH concentrations. These results suggest antioxidant protective effects of moderate systemic hypothermia in metabolically active brain stem tissue during hemorrhagic shock. Similar effects in humans remain to be studied.

From the Departments of Emergency (H.G., Z.D.), Biochemistry (R.A., C.C.), and Surgery (Z.M., E.K., K.O.), Ondokuz Mayis University School of Medicine, Samsun, Turkey.

Submitted for publication October 9, 2000.

Accepted for publication January 29, 2002.

Supported by the Ondokuz Mayis University Department of Research Fund Grant No. T-258.

Presented at the 9th Biennial Meeting of the European Shock Society, May 25–27, 2000, Nijmegen, The Netherlands.

Address for reprints: Hakan Guven, MD, Department of Surgery, Ondokuz Mayis University School of Medicine, 55139 Samsun, Turkey; email: or

© 2002 Lippincott Williams & Wilkins, Inc.