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Fluid Resuscitation Increases Inflammatory Gene Transcription After Traumatic Injury

Watters, Jennifer M. MD; Tieu, Brandon H. MD; Todd, S Rob MD; Jackson, Terisa BA; Muller, Patrick J. BS; Malinoski, Darren MD; Schreiber, Martin A. MD

The Journal of Trauma: Injury, Infection, and Critical Care: August 2006 - Volume 61 - Issue 2 - p 300-309
doi: 10.1097/01.ta.0000224211.36154.44
Original Articles
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Background: The debate continues over type and quantity of fluid to administer for resuscitation after traumatic injury. This study aimed to examine effects of resuscitation with lactated Ringer’s (LR) and Hextend (HEX) on the inflammatory response after uncontrolled hemorrhagic shock (UHS).

Methods: There were 38 swine randomized. Control swine were anesthetized and killed. Sham swine underwent laparotomy, splenectomy, and 2 hours of anesthesia. UHS swine received a grade V liver injury after laparotomy and splenectomy and were randomized to no fluid (NF) resuscitation or to blinded resuscitation 30 minutes after injury with LR or HEX. Fluids were infused as needed to maintain baseline blood pressure for 90 minutes. Lung tissue mRNA levels of interleukin-6 (IL-6), granulocyte colony stimulating factor (G-CSF), and tumor necrosis factor alpha (TNF-α) were determined. Lung sections were examined for neutrophils (PMNs) sequestered within alveolar walls.

Results: All UHS animals survived and initial blood loss was similar between groups. Mean arterial pressures (MAPs) were similar for all UHS animals until resuscitation was initiated. MAPs of resuscitated animals remained similar and were significantly higher than MAPs of the NF animals. Sequestered PMNs were equally elevated in all UHS animals. Cytokine analysis showed increased IL-6, G-CSF, and TNF-α gene transcription in resuscitated swine compared with NF swine. LR and HEX resuscitated swine tissue mRNA levels showed no differences.

Conclusions: Fluid resuscitation after solid organ injury and uncontrolled hemorrhage results in greater proinflammatory gene transcription than no resuscitation. LR and HEX resuscitation have equivalent effects on indices of inflammation in the lungs.

From the Oregon Health & Science University, Portland, Oregon (J.M.W., B.H.T., T.J., P.J.M., D.M., M.A.S.); The University of Texas Health Science Center at Houston (S.R.T.), Houston, Texas.

Submitted for publication May 11, 2005.

Accepted for publication April 11, 2006.

Presented at the Northwest Regional Committee on Trauma Resident Paper Competition, December 11, 2004.

Presented at the 18th Annual Meeting of the Eastern Association for the Surgery of Trauma, January 12–15, 2005, Ft. Lauderdale, Florida.

This work was supported in its entirety by US Army Medical Research Acquisition Activity Award #W81XWH-04-1-0104.

Address for reprints: Jennifer M. Watters, 3181 SW Sam Jackson Park Road, L223A, Portland, OR 97239; email: wattersj@ohsu.edu.

© 2006 by Lippincott Williams & Wilkins