Conventional Resuscitation Group Research Articles

Protective effect of restrictive resuscitation on vascular endothelial glycocalyx in pigs with traumatic hemorrhagic shock.

BackgroundHemorrhagic shock is the leading cause of early traumatic death. Research and discussion on restrictive fluid resuscitation have been ongoing for many years. The purpose of this study was to explore whether restrictive resuscitation can inhibit the shedding of vascular endothelial glycocalyx in the prehospital treatment of traumatic hemorrhagic shock pigs.MethodsLandrace pigs were randomly divided into a restrictive resuscitation group (restrictive group) and a conventional resuscitation group (conventional group), with 6 pigs in each group. The gunshot caused a rupture of the pig’s receding right femoral artery, and the average arterial pressure was 40–45 mmHg stable for 30 minutes, which was defined as a successful shock model. The end point of resuscitation in the restrictive group was a mean arterial pressure (MAP) of 55–60 mmHg for 30 minutes, and the end point of resuscitation in the conventional group was a MAP of 70–75 mmHg for 30 minutes. The results of arterial blood gas analysis, hemodynamic indicators, endothelial glycocalyx damage and shedding marker Syndecan1 and soluble thrombomodulin (sTM) expression levels were compared between the two groups of experimental pigs after resuscitation.ResultsThe two groups of experimental pigs had the same baseline levels before injury in age, body weight, blood loss, cardiac output index, cardiac function index (CFI), extravascular lung water index (ELWI), and pulmonary vascular permeability index (PVPI). The arterial blood gas analysis of the two experimental pigs showed no significant difference in carbon dioxide partial pressure, oxygen partial pressure, blood oxygen saturation, or blood lactic acid after resuscitation. The difference in cardiac output index and CFI at the end of resuscitation between the two groups was not statistically significant; the absolute value and percentage of Syndecan1 level increase in the restrictive resuscitation group were lower than those in the conventional resuscitation group, and the difference was statistically significant.ConclusionsCompared with full resuscitation in a short period of prehospital treatment, restrictive resuscitation can achieve a similar effect in maintaining tissue oxygen supply and can reduce the loss of vascular endothelial glycocalyx to a certain extent.

Randomized Controlled Trial Evaluating the Efficacy of Peritoneal Resuscitation in the Management of Trauma Patients Undergoing Damage Control Surgery

Peritoneal resuscitation (PR) represents a unique modality of treatment for severely injured trauma patients requiring damage control surgery. These data represent the outcomes of a single institution randomized controlled trial into the efficacy of PR as a management option in these patients. From 2011 to 2015, one hundred and three patients were enrolled in a prospective randomized controlled trial evaluating the use of PR in the treatment of patients undergoing damage control surgery compared with conventional resuscitation (CR) alone. Patient demographics, clinical variables, and outcomes were collected. Univariate and multivariate analysis was performed with a priori significance at p ≤ 0.05. After initial screening, 52 patients were randomized to the PR group and 51 to the CR group. Age, sex, initial pH, and mechanism of injury were used for randomization. Method of abdominal closure was standardized across groups. Time to definitive abdominal closure was reduced in the PR group compared with the CR group (4.1 ± 2.2 days vs 5.9 ± 3.5 days; p ≤ 0.002). Volume of resuscitation and blood products transfused in the initial 24 hours was not different between the groups. Primary fascial closure rate was higher in the PR group (83% vs 66%; p ≤ 0.05). Intra-abdominal complications were lower in the PR compared with the CR group (8% vs 18%), with abscess formation rate (3% vs 14%; p<0.05) being significant. Patients in the PR group had a lower 30-day mortality rate, despite similar Injury Severity Scores (13% vs 28%; p= 0.06). Peritoneal resuscitation enhances management of damage control surgery patients by reducing time to definitive abdominal closure, intra-abdominal infections, and mortality rates.

Effect of dexmedetomidine on concentrations of hydrogen sulfide, neuron-specific enolase and S100β after cardiopulmonary resuscitation in rats

Objective To study the effect of dexmedetomidine on concentrations of hydrogen sulfide (H2S),neuron-specific enolase (NSE) and S100β after cardio-pulmonary resuscitation (CPR) in rats.Methods Sixty SD rats were devided into three groups:sham group (group A),conventional resuscitation group (group B) and dexmedetomidine group (group C) (n =20 each).Blood gas analysis before was compared before asphyxia and after resuscitation among 3 groups.The neurologic deficit scoring (NDS) and the concentrations of H2S,NSE and S100β were compared also.Results After resuscitation,the PaO2 in groups B and C [(45.48 ±5.98) and (48.26 ±6.93) mmHg (1 mmHg =0.133 kPa)] was decreased as compared with before asphyxia [(92.15 ±2.87) and (91.89 ±2.76) mmHg],and PaCO2 [(57.32 ±7.15) and (53.68 ±3.58) mmHg] increased as compared with before asphyxia [(32.98 ± 2.14) and (32.70 ±3.32) mmHg,P ＜0.05].There was significant difference in NDS concentration between groups B and C at different time points (P ＜ 0.05).At 24,48 and 72 h after CPR,there was significant difference in NDS concentration between groups B and C (45.97 ± 5.78,41.32 ±4.79,40.56 ±4.43 and 32.25 ± 4.22,25.82 ± 3.98,17.96 ± 2.79,P ＜ 0.05).There was significant difference in the concentrations of H2S,NSE and S100β between groups B and C at different time points (P ＜ 0.05).At 4,12,24,48 and 72 h after CPR,there was statistically significant difference in H2S and NSE concentrations between groups B and C (P ＜0.05) ; at 12,24,48 and 72 h after CPR,there was significant difference in S100β concentration between groups B and C (P ＜ 0.05).Conclusion Dexmedetomidine can increase the concentrations of H2S as well as reduce the concentrations of NSE and S100β in serum,and it has protective effects on brain of rats to a certain extent. Key words: Dexmedetomidine; Cardiopulmonary resuscitation; Hypoxic ischemic brain damage

Effects of dexmedetomidine preconditioning on cerebral hypoxia-ischemia injury in rats

Objective To investigate the effects of dexmedetomidine preconditioning on cerebral hypoxia-ischemia injury in rats. Methods Seventy-two adult male Sprague-Dawley (SD) rats weighing 250-300 g were randomly divided into 3 groups: sham group (Group S), conventional resuscitation group (Group C) and dexmedetomidine preconditioning group (Group D). Cerebral hypoxia-ischemia injury rat model was produced by mechanical asphyxia. In Group D, 4 μ g/kg dexmedetomidine was injected intravenously 5 min before asphyxia. The Neurological Deficit Scale (NDS) was assessed at 12, 24, 48 and 72 h after return of spontaneous circulation. Six rats were sacrificed in each group and brain tissues were removed for microscopic examination of hippocampal CA1 region and ultrastructure by electron microscope. Results The PaO 2 in Group D and C rats was significantly lower after resuscitation ( P = 0.000, for all), while the PaCO 2 was increased as compared with before asphyxia ( P = 0.000, for all). Compared with Group S, NDS at each time point were significantly increased in Group C ( P = 0.000, for all). Compared with Group C, NDS were significantly decreased at 24, 48 and 72 h in Group D ( P = 0.000, for all). Compared with Group C, hippocampal neurons in Group D revealed alleviative necrosis, karyopyknosis and karyolysis, as well as increased number of survival neurons and relieved edema. Besides, there was good microenvironment of neurovascular unit and no obvious demyelination. Conclusions Dexmedetomidine preconditioning can attenuate cerebral hypoxia?ischemia injury in rats, and improve the pathologic changes and ultrastructure of neurons of hippocampus. doi: 10.3969/j.issn.1672-6731.2014.05.012

A Pilot Comparison of Limited Versus Large Fluid Volume Resuscitation in Canine Spontaneous Hemoperitoneum

Treatment for hemorrhagic shock secondary to a spontaneous hemoperitoneum includes restoration of IV volume and surgical control of hemorrhage. This study was designed to determine if limited fluid volume resuscitation (LFVR) with hypertonic saline (HS) and hyperoncotic fluids (hydroxyethylstarch [HES]) results in more rapid cardiovascular stabilization in dogs with spontaneous hemoperitoneum versus conventional resuscitation (CR) with large volume resuscitation. Eighteen client-owned dogs presenting in hemorrhagic shock with a spontaneous hemoperitoneum were enrolled. Dogs were randomized to be fluid resuscitated with up to 90 mL/kg of an isotonic crystalloid (CR group) or up to 8 mL/kg of 7.2% Na chloride (i.e., HS) combined with up to 10 mL/kg of 6% HES. Measurements of vital signs, lactate, packed cell volume (PCV), total solids (TS), and blood pressure were made at standard time points. The primary end point was time to stabilization of hemodynamic parameters (measured in min). Dogs in the LFVR group achieved hemodynamic stabilization significantly faster (20 min; range, 10-25 min) than those in the CR group (35 min; range, 15-50 min; P = .027). Future studies are warranted to further investigate potential benefits associated with LFVR in dogs with spontaneous hemoperitoneum.

Effects of direct peritoneal resuscitation with sodium pyruvate from hemorrhagic shock on intestinal injury in rats

Objective To investigate the effects of direct peritoneal resuscitation (DPR) with sodium pyruvate from hemorrhagic shock (HS) on intestinal injury in rats.Methods Fifty SPF male Sprague-Dawley rats,weighing 200-250 g,were used in this study.The animals were anesthetized with 1％ pentobarbital sodium 40 mg/kg,tracheostomized and mechanically ventilated.Femoral artery was cannulated for mean arterial pressure (MAP) monitoring,blood-letting,blood sampling and fluid infusion.HS was induced according to the method described by Wiggers.MAP was maintained at 35-40 mm Hg for 60 min.The animals were then randomly and equally divided into 5 groups:sham operation group (group S) ; conventional resuscitation group (group CR) ; DPR with different fluid groups (DPRt-3 groups).In group CR,at 1 h after HS,the animals were resuscitated with infusion of the blood withdrawn and normal saline (the volume was 2 times volume of blood loss).In DPR1-3 groups,conventional resuscitation was performed,at the same time,1.5 ％ glucose-based peritoneal dialysis solution containing lactate,1.5％ glucose-based peritoneal dialysis solution containing lactate (40.00 mmol/L),and 1.5％ glucosebased peritoneal dialysis solution containing high lactate (80.00 mmol/L) 20 ml were infused intraperitoneally over 30 min,respectively.MAP was recorded before blood letting,at 5,30 and 60 min of HS,and at 5,30,60,90 and 120 min after the end of resuscitation.At 120 min after the end of resuscitation,the lactate level in the arterial blood was measured.The animals were then sacrificed.Small intestinal samples were obtained for determination of malondialdehyde (MDA) content,myeloperoxidase (MPO) activity and tumor necrosis factor-α (TNF-α) expression,and for microscopic examination.The damage to the small intestinal mucosa was assessed and scored.Results Compared with MAP before blood letting,MAP during HS was significantly decreased,and no significant change in MAP was found after resuscitation in CR and DPR1-3 groups (P ＜ 0.05).The lactate level in the arterial blood,MDA content,MPO activity,TNF-α expression and intestinal mucosal damage scores were significantly higher in CR and DPR1-3 groups than in S group (P ＜ 0.05 or 0.01),while lower in DPR1-3 groups than in CR group (P ＜0.01),and in DPR2,3 groups than in DPR1 group (P ＜ 0.05 or 0.01).The lactate level in the arterial blood,MDA content and TNF-α expression were significantly lower in DPR3 group than in DPR2 group (P ＜ 0.05 or 0.01).Conclusion Direct peritoneal resuscitation with sodium pyruvate can reduce the intestinal injury induced by HS and inhibition of lipid peroxidation and inflammatory responses is involved in the mechanism in rats. Key words: Pyruvic acid; Peritoneal dialysis; Resuscitation; Shock, hemorrhagic; Intestines; Reperfusion injury

Neuroprotective role of Batroxobin in cardiopulmonary resuscitation rabbits*

Background Batroxobin has been found to have protective effect on cerebral ischemia-reperfusion, and cardiopulmonary resuscitation (CPR) is the common cause of global brain ischemia-reperfusion. Objective To observe the effect of Batroxobin on the morphological results of cerebral cortex and hippocampus in rabbit models of CPR, and the changes of serum concentration of tumor necrosis factor alpha (TNF-a) after CPR. Design A randomized controlled observation. Setting Laboratory of the Department of Burns, Changhai Hospital affiliated to the Second Military Medical University of Chinese PLA. Materials Thirty healthy New Zealand rabbits of 2.5-3.0 kg, either male or female, were used. Kits for TNF-a determination were provided by LIFEKEY BioMeditech Company (USA). Methods The experiments were carried out in the laboratory of Department of Burns, Changhai Hospital from February 2001 to January 2002. The 32 rabbits were randomly divided into sham-operated group ( n=8), conventional resuscitation group ( n=12) and Batroxobin-treated group ( n=12). The animals in the conventional resuscitation group and Batroxobin-treated group were anesthetized, then induced into modified Pittsburg's model of mechanical ventricular fibrillation. Sham-operated group was discharged on the chest wall, which did not cause ventricular fibrillation. Conventional resuscitation group and Batroxobin-treated group were exposed to 6 minutes of cardiac arrest induced by ventricular fibrillation, then the resuscitation began. A dosage of 0.3 Bu/kg of Batroxobin was administered to the rabbits in the Batroxobin-treated group at the beginning of resuscitation. Blood sample was collected at 4 and 12 hours after CPR to determine the concentration of TNF-a in serum. After the second blood collection, brain tissue was taken out immediately, and the forms of nerve cells in cerebral cortex and hippocampal CA1 region were observed under light microscope. Main outcome measures ▪ TNF-aconcentration in serum at 4 and 12 hours after CPR; ▪ Forms of nerve cells in cerebral cortex and hippocampal CA1 region at 12 hours after CPR. Results All the 31 New Zealand rabbits were involved in the analysis of results. ▪ TNF-a concentration in serum: At 4 hours after CPR, the TNF-a concentrations in serum in the conventional resuscitation group and Batroxobin-treated group [(5.947±2.366), (5.122±2.521) ng/L] were significantly higher than that in the sham-operated group [(2.604±1.623) ng/L, P < 0.05]. At 12 hours after CPR, the TNF-a concentration in serum in the conventional resuscitation group was (7.770±3.121) ng/L, it was significantly higher than that at 4 hours ( P < 0.05), also significantly higher than that in the Batroxobin-treated group [(5.425±2.280) ng/L, P < 0.05]. ▪ Forms of nerve cells: In the sham-operated group, no abnormality was found in the hippocampal CA1 region and cerebral cortex. In the conventional resuscitation group, the pyramidal cells in hippocampal CA1 region were lined up in disorders, and edema, puff, vacuolization, nucleus concentration and anachromasis were also observed appeared; Edema of nerve cells, vacuole, pyknosis appeared in cerebral cortex; microthrombosis appeared in some blood capillaries. As compared with the conventional resuscitation group, cellular edema was relieved and pyknosis of nerve cells were obviously reduced, and no microthrombosis was found in hippocampal CA1 region and cerebral cortex in the Batroxobin-treated group. Conclusion Batroxobin have neuroprotective effect on CPR rabbits, and may inhibit the excessive increase of TNF-a concentration in serum.