Hemorrhagic Shock and Resuscitation-Mediated Tissue Water Distribution is Normalized by Adjunctive Peritoneal Resuscitation

• Published in: Journal of the American College of Surgeons Vol. 206; no. 5; pp. 970 - 980
• Main Authors: Zakaria, El Rasheid, MD, PhD, Matheson, Paul J., PhD, Flessner, Michael F., MD, PhD, Garrison, R. Neal, MD, FACS
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.05.2008
• Subjects: Animals; Blood Transfusion; Disease Models, Animal; Edema - etiology; Edema - physiopathology; Fluid Therapy; Male; Peritoneal Dialysis - methods; Peritoneum; Rats; Rats, Sprague-Dawley; Resuscitation - methods; Shock, Hemorrhagic - complications; Shock, Hemorrhagic - physiopathology; Shock, Hemorrhagic - therapy; Surgery; Water-Electrolyte Balance - physiology; Water-Electrolyte Imbalance - etiology; Water-Electrolyte Imbalance - physiopathology; Water-Electrolyte Imbalance - therapy; conventional resuscitation; direct peritoneal resuscitation; intraperitoneal; QAR; quantitative autoradiography; interstitial fluid volume; DPR; IP; intravascular volume; hemorrhagic shock; IVV; HS; intracellular water volume; CR; total tissue water; extracellular volume; TTW; IFV; ECV; ICV
• DOI: 10.1016/j.jamcollsurg.2007.12.035
• ISSN: 1072-7515

Background Adjunctive direct peritoneal resuscitation (DPR) from hemorrhagic shock (HS) improves intestinal blood flow and abrogates postresuscitation edema. HS causes water shifts as a result of sodium redistribution and changes in transcapillary Starling forces. Conventional resuscitation (CR) with crystalloid aggravates water sequestration. We examined the compartment pattern of organ tissue water after HS and CR, and modulation of tissue edema by adjunctive DPR. Study Design Rats were hemorrhaged (40% mean arterial pressure for 60 minutes) and assigned to four groups (n = 7): sham, no HS; HS no resuscitation; HS+CR (shed blood plus 2 volumes Ringer's lactate); and HS+CR+DPR (20 mL clinical intraperitoneal (IP) dialysis fluid). Isotopic markers determined equilibrium distribution volumes [VD ] in gut, liver, lung, and muscle by quantitative autoradiography (2-hour postresuscitation). Total tissue water (TTW) was determined by wet-dry weights. Extracellular water was measured from14 C-mannitol VD , and intravascular volume (IVV) from131 I-labeled IgG VD . Cellular and interstitial water volumes were calculated. Results HS alone decreased IVV in all tissues and TTW in gut, lung, and muscle, but not liver, compared with shams. IVV remained decreased with all resuscitations despite restoration of central hemodynamics. CR caused interstitial edema in gut, liver, and muscle, and cellular edema in lung. DPR reduced (liver, muscle) or prevented (gut, lung) these volume shifts. Conclusions HS decreases IVV. HS-induced water shifts are organ-specific and prominent in gut, lung, and muscle. CR restores central hemodynamics, does not restore IVV, and alters organ-specific TTW distribution. Adjunctive DPR with IP dialysis fluid normalizes TTW and water compartment distribution and prevents edema. Combined effect of DPR and intravascular fluid replacement appears to prevent global tissue edema and improve outcomes from HS.