Hypertonic Saline Resuscitation Decreases Susceptibility to Sepsis after Hemorrhagic Shock

Coimbra, Raúl; Hoyt, David B.; Junger, Wolfgang G.; Angle, Niren; Wolf, Steven E.; Loomis, William; Evers, Michael F.

doi:10.1097/00005373-199704000-00004

Cited by 182 publications

(99 citation statements)

References 26 publications

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“…Our findings are consistent with several previous studies in which intravenous hyperosmolar infusions were reported to prevent lung injury (5)(6)(7)(8). However, for the consideration of hyperosmolar infusion in clinical therapy, the role of the endothelium must be further clarified especially with regard to the manner in which barrier protection is initiated and is maintained in intact models of lung injury.…”

Section: Discussionsupporting

confidence: 92%

“…Hyperosmolar infusions, which are commonly applied in resuscitation therapy (4), suppress lung injury (5)(6)(7)(8), inhibit expression of endothelial leukocyte adhesion molecules (8,9), and block the proinflammatory effects of lipopolysaccharide (8). Furthermore, hyperosmolar infusions expand blood volume (10,11) and cause hemodilution (10), suggesting that the capillary barrier remains intact despite the potential cellshrinkage effect of hyperosmolarity (12).…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Hyperosmolarity enhances the lung capillary barrier

Safdar¹,

Wang²,

Ichimura³

et al. 2003

J. Clin. Invest.

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Section: Discussionsupporting

confidence: 92%

Section: Introductionmentioning

confidence: 99%

Hyperosmolarity enhances the lung capillary barrier

Safdar¹,

Wang²,

Ichimura³

et al. 2003

J. Clin. Invest.

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“…45 More recently, a series of experiments have shown that hypertonic saline solution, even without dextran, significantly interferes with the immune responses, both in vitro and in vivo. [46][47][48][49][50][51][52][53][54][55][56][57] The addition of hypertonic saline solution to a lymphocyte culture media, in concentrations similar to those obtained with systemic infusion of 4 mL/kg of 7.5% NaCl in humans, determined a significant increase in lymphocyte proliferation. 46 The addition of prostaglandin E 2 (PGE 2 ) to the culture media, in the absence of hypertonic saline, caused a reduction in T-cells proliferation, when compared to control cultures.…”

Section: Immune and Inflammatory Effects Of Hs/ Hsdmentioning

confidence: 99%

Small Volume Hypertonic Resuscitation of Circulatory Shock

Rocha-e-Silva

Figueiredo

2005

Clinics

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Small volume hypertonic resuscitation is a relatively new conceptual approach to shock therapy. It was originally based on the idea that a relatively large blood volume expansion could be obtained by administering a relatively small volume of fluid, taking advantage of osmosis. It was soon realized that the physiological vasodilator property of hypertonicity was a useful byproduct of small volume resuscitation in that it induced reperfusion of previously ischemic territories, even though such an effect encroached upon the malefic effects of the ischemia-reperfusion process. Subsequent research disclosed a number of previously unsuspected properties of hypertonic resuscitation, amongst them the correction of endothelial and red cell edema with significant consequences in terms of capillary blood flow. A whole set of actions of hypertonicity upon the immune system are being gradually uncovered, but the full implication of these observations with regard to the clinical scenario are still under study. Small volume resuscitation for shock is in current clinical use in some parts of the world, in spite of objections raised concerning its safety under conditions of uncontrolled bleeding. These objections stem mainly from experimental studies, but there are few signs that they may be of real clinical significance. This review attempts to cover the earlier and the more recent developments in this field.

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“…The rationale for selecting cecal ligation and puncture (CLP) as a septic model is that CLP induces effects analogous to a perforated appendicitis. 3,6,7 The infectious milieu promotes microbial growth or impairs host defenses, which can be quickly modified by surgical source control. 3,5 Therefore, surgical removal of the septic focus has been applied as a key component of success in therapy of ongoing sepsis.…”

Section: Introductionmentioning

confidence: 99%

In Vivo Observation of Mesenteric Leukocyte-Endothelial Interactions After Cecal Ligation/Puncture and Surgical Sepsis Source Control

Nakagawa

Jukemura

Aikawa

et al. 2007

Clinics

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Nakagawa NK; Jukemura J, Aikawa P, Nogueira RA, Poli-de-Figueiredo LF, and Sannomiya P. In vivo observation of mesenteric leukocyte-endothelial interactions after cecal ligation/puncture and surgical sepsis source control. Clinics. 2007;62(3):321-6. PURPOSE: Cecal ligation and puncture (CLP) has been used as a useful model for the induction of polymicrobial sepsis. Necrotic tissue resection and peritoneal lavage (REL) are the surgical procedures for controlling perforated appendicitis. The aim of this study was to evaluate leukocyte-endothelial interactions in the rat mesentery in vivo after CLP and REL. METHODS: Thirty-seven male Wistar rats (250-300 g) underwent laparotomy and were randomly assigned to the following groups: 1) SHAM; 2) CLP: animals submitted to CLP, 3) CLP+REL: animals submitted to CLP and REL. Mesenteric leukocyteendothelial interactions were studied by intravital microscopy assessed once in each animal (3-5 postcapillary venules, 15-25 µm diameter) 24 hours after intervention. Follow-up was performed in all animals; this included analysis of glycemia, lactate, hematocrit, white blood cell count as well as a functional score that was the sum of scoring on the following parameters: alertness, mobility, piloerection, diarrhea, encrusted eyes, and dirty nose and tail. RESULTS: None of the animals showed significant changes in body weight (265 ± 20 g) or in hematocrit levels (46% ± 2%) during the experimental protocol. Compared to SHAM animals, CLP animals showed an increased number of rolling (2x), adherent, and migrating leukocytes (7x) in the mesenteric microcirculation, an increase in blood glucose (136 ± 8 mg/dL), lactate (3.58 ± 0.94 mmol/L), white cell count (23,570 ± 4,991 cells/mm 3 ) and functional alterations (score 11 ± 1), characterized by impaired alertness and mobility, and presence of piloerection, diarrhea, encrusted eyes, and dirty nose and tail. The REL procedure normalized the number of rolling, adherent, and migrated leukocytes in the mesentery; glycemia; lactate; and white blood cell count. The REL procedure also improved the functional score (7 ± 1). CONCLUSION: Local and systemic inflammation was induced by CLP, while REL completely overcame the inflammatory process.

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Hypertonic Saline Resuscitation Decreases Susceptibility to Sepsis after Hemorrhagic Shock

Cited by 182 publications

References 26 publications

Hyperosmolarity enhances the lung capillary barrier

Hyperosmolarity enhances the lung capillary barrier

Small Volume Hypertonic Resuscitation of Circulatory Shock

In Vivo Observation of Mesenteric Leukocyte-Endothelial Interactions After Cecal Ligation/Puncture and Surgical Sepsis Source Control

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