Fluid compartments in hemorrhaged rats after hyperosmotic crystalloid and hyperoncotic colloid resuscitation

Abstract

Postresuscitation organ failure may be associated with detrimental changes in body fluid compartments. We measured how shock and resuscitation acutely alters the interstitial, cellular, and plasma compartments in different organs. Nephrectomized, anesthetized rats were bled to 50 mmHg mean arterial pressure for 1 h, followed by 60 min of resuscitation to restore blood pressure using 0.9% normal saline (NS,n = 10), 7.5% hypertonic saline (HS,n = 8), 10% hyperoncotic albumin (HA, n = 8), or 7.5% hypertonic saline and 10% hyperoncotic albumin (HSA, n = 7). A 2-h 51Cr-EDTA distribution space estimated extracellular fluid volume (ECFV), and a 5-min 125I-labeled albumin distribution space measured plasma volume (PV). Total tissue water (TW) was measured from wet and dry weights; interstitial fluid volume (ISFV) and cell water were calculated. NS resuscitation required 7 times more fluid (50.9 +/- 7.7 vs. 8.6 +/- 0.7 for HA, 5.9 +/- 0.4 for HS, and 3.9 +/- 0.5 ml/kg for HSA), but there were no differences between solutions in whole animal PV, ECFV, or ISFV. Fluid shifts within tissues depended on resuscitation solution and type of tissue. TW was significantly reduced by hypertonic saline groups in heart, muscle, and liver (P < 0.05). ISFV was significantly reduced by HA groups in the skin. In all tissues, mean cell water in groups receiving HS was smaller; this was significant for heart, lung, muscle, and skin. In conclusion, 1) HS solutions mobilize fluid from cells while expanding both PV and ISFV, and 2) TW and cellular water increase with both isotonic crystalloids and hyperoncotic colloids in many tissues.

Hypertonic Saline Resuscitation of Hemorrhagic Shock Diminishes Neutrophil Rolling and Adherence to Endothelium and Reduces In Vivo Vascular Leakage

“…51 Following the resuscitation of hemorrhagic shock, postmortem studies revealed less radioactive albumin leakage into pulmonary tissue if HTS was used for resuscitation instead of RL. 15,52 The present study represents the first attempt at characterizing in vivo postcapillary venous permeability following resuscitation of systemic hemorrhagic shock. Leakage of labeled albumin was evaluated with epifluorescence microscopy and revealed almost 50% less leakage if HTS was used for resuscitation instead of RL.…”

Effect of Hypertonic Saline Pre-treatment on Ischemia–Reperfusion Lung Injury in Pig

“…17,18 Indeed, the increase in pulmonary blood flow increases the capillary filtration coefficient. 18 To differentiate a direct effect of hyperosmolarity on the endothelium permeability from a hemodynamic effect of hypertonic saline, some animals received the same amount of isotonic sodium, 16 which induced a similar increase in the cardiac index without any significant modification of blood osmolarity. It did not worsen ischemia-reperfusion lung injury, which strongly suggests a direct role of hyperosmolarity.…”

“…Some of them could limit pulmonary edema, such as the immunomodulatory properties of hypertonic saline 7,8 or its vasodilator properties on pulmonary circulation. 14,15 Others may potentiate edema, such as the increase in endothelial permeability induced by blood hyperosmolarity, [11][12][13] the effect of sodium input on lung water accumulation, 16 or the increase in cardiac output. 17,18 In the present study, we evaluated the effects of a pre-treatment by intravenous hypertonic saline in a clinically reliable model of ischemia-reperfusion such as encountered during lung transplantation.…”

Osmolality- and Na+-dependent effects of hyperosmotic NaCl solution on contractile activity and Ca2+ cycling in rat ventricular myocytes

“…However, only after the studies by Velasco et al [44] and De Felippe et al [19] that demonstrated that the infusion of a small volume of 7.5% NaCl solution (2.4 Osm/kg) was effective to promote resuscitation from hypovolemic shock in dogs and humans have hypertonic solutions been considered for clinical treatment of circulatory shock and other conditions associated with impaired tissue perfusion, as well as of brain injury (e.g., [13,15,40,42]). The beneficial effects of this treatment have been attributed to endocrine changes, modulation of immune responses, fluid redistribution, and restoration of microvascular blood flow, possibly involving precapillary vasodilation and reversal of capillary narrowing that occurs during shock [34,36,39,40,42]. Although addition of other solutes to hypertonic saline has been common in the so-called small volume resuscitation, increase in plasma Na + concentration was shown to be essential for successful resuscitation [41].…”