Lactated Ringer???s Solution and Hetastarch but Not Plasma Resuscitation after Rat Hemorrhagic Shock Is Associated with Immediate Lung Apoptosis by the Up-regulation of the Bax Protein

Deb, Subrato; Sun, Leon; Martin, Barry; Talens, Eric; Burris, David; Kaufmann, Christoph; Rich, Norman M.; Rhee, Peter

doi:10.1097/00005373-200007000-00007

Cited by 82 publications

(49 citation statements)

References 14 publications

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“…ThS patients tend to be at risk of developing hypovolemia, with subsequent tissue malperfusion and organ dysfunction. although blood volume therapy can help to maintain hemodynamic stability and diminish the risk of developing hypovolemia and its effects, ThS has been shown to induce histological injury, which is an impor- tant contributor to cell dysfunction, organ failure, and mortality [4]. We examined the effects of ThS on hemodynamics, microvascular tissue perfusion (Fig.…”

Section: Discussionmentioning

confidence: 99%

Establishment of an Experimental Mouse Model of Trauma-Hemorrhagic Shock

et al. 2012

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This study established an experimental mouse model of trauma-hemorrhagic shock (THS). THS-induced mice (C57BL/6J, n=33) were subjected to femoral fracture, ischemia for 90 min, and resuscitation for 15 min. The sham-operated mice (C57BL/6J, n=33) underwent the same anesthetic and surgical procedures, but neither trauma-hemorrhage nor fluid resuscitation were performed. Mean arterial pressure (MAP) and microvascular tissue perfusion over the small intestine, liver, and left kidney were longitudinally measured in all mice. Blood was collected for analysis at baseline and 3, 6, 12, and 24 h post resuscitation, and the small intestine, liver, and left kidney were resected for hematoxylin and eosin staining 24 h post resuscitation. Compared with the sham group, MAP and microvascular tissue perfusion over the small intestine, liver, and left kidney were all significantly reduced in the THS group at the end of hemorrhage. Following resuscitation, no significant differences were observed between the groups. THS induction was associated with significantly increased plasma concentrations of Cr, AST, CPK, IL-6, IL-10, and TNF-α from the baseline values by two-to three-fold after the hemorrhage phase, and THS-induced mice demonstrated significantly increased histological injury scores. The rapid drop in MAP and microvascular tissue perfusion observed following THS induction, and the gradual recovery post resuscitation, reflects the successful establishment of a THS experimental mouse model.

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Section: Discussionmentioning

confidence: 99%

Establishment of an Experimental Mouse Model of Trauma-Hemorrhagic Shock

et al. 2012

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“…Yet the amnion is remarkably different than the blood vessel endothelium and may have different nutritional requirements. Interestingly, even when used for shock resuscitation, compared to resuscitation with whole blood, resuscitation with LR increased cellular apoptosis through a mechanism which involved upregulation of Bax protein (30).…”

Section: Articlesmentioning

confidence: 99%

Histologic changes of the fetal membranes after fetoscopic laser surgery for twin-twin transfusion syndrome

et al. 2015

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Background: Preterm premature rupture of membranes remains a major complication after fetoscopic laser surgery (FLS) for twin-twin transfusion syndrome (TTTS). We studied the histologic changes of fetal membranes post-FLS and investigated a possible impact of amniotic fluid (AF) dilution. Methods: Fetal membranes of 31 pregnancies that underwent FLS for TTTS were investigated histologically at delivery at different sites: trocar site of recipient sac and at distance, donor sac, and inter-twin membrane. results: The trocar insertion site on the recipient sac showed no signs of histologic hallmarks of healing. Wide-spread alteration in collagen organization and higher apoptotic index in the amnion of the recipient sac which were absent in donor's and reference membranes. To explain the mechanisms, we analyzed the AF composition of recipient sacs from TTTS pregnancies vs. GA-matched healthy singleton controls and found glucose, protein and lactate dehydrogenase activity were all significantly lower in TTTS sacs consistent with over-dilution of recipient's AF (~2-fold). In-vitro exposure of healthy amniochorion to analogous dilutional stress conditions recapitulated the histologic changes and induced apoptosis and autophagy. conclusion: Alteration in structural integrity of the recipient's amniochorion, possibly in response to dilution stress, along with ineffective repair mechanisms may explain the increased incidence of preterm birth post-FLS.d espite the success of fetoscopic laser surgery (FLS) for the treatment of severe twin-twin transfusion (TTTS), preterm delivery with or without preterm premature rupture of membranes (PPROM) remains a major complication (1-4). The average gestational age at delivery after procedure ranges between 29 to 33 wk (1,5). Aside from the cost of caring for the premature infants, preterm delivery is directly associated with long-term neurological deficits in TTTS (4,6), undermining the complete benefits of such intervention. PPROM which affects 20-32% of cases is the most important risk factor leading to preterm delivery (2,7-10).Considered a minimally invasive procedure, FLS necessitates the insertion of a trocar into the amniotic cavity of the recipient twin to allow for insertion of the fetoscope (through a cannula which stays in place throughout the procedure) (11). A laser is used to seal the abnormal blood vessel anastomoses between the monochorionic twin placentas. Lastly, the surgeon performs an amnioreduction to relieve the recipient's polyhydramnios by draining the excess amniotic fluid (AF) through the cannula before removing it. During the procedure to allow proper visualization due to the inadvertent loss of amniotic fluid through cannula port or due to cloudy AF, it is customary for the surgeon to remove a volume of AF and replace it via amnioinfusion with a solution of Lactated Ringer's (LR).Fetal membranes are the outermost layer of fetal compartment in apposition to maternal decidua. The amniotic layer of the fetal membranes is made up of a lining of cuboidal epithe...

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“…It has been recognized for the past decade that crystalloids are proinflammatory. 41 In a recent study, Robinson et al showed that crystalloid infusion was more strongly associated with hypoxia than was plasma. 42 This association has been called crystalloid-associated lung injury and the deleterious effects of crystalloid infusion are becoming more widely recognized.…”

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confidence: 99%

Optimal trauma resuscitation with plasma as the primary resuscitative fluid: the surgeon's perspective

Holcomb¹,

2013

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Over the past century, blood banking and transfusion practices have moved from whole blood therapy to components. In trauma patients, the shift to component therapy was achieved without clinically validating which patients needed which blood products. Over the past 4 decades, this lack of clinical validation has led to uncertainty on how to optimally use blood products and has likely resulted in both overuse and underuse in injured patients. However, recent data from both US military operations and civilian trauma centers have shown a survival advantage with a balanced transfusion ratio of RBCs, plasma, and platelets. This has been extended to include the prehospital arena, where thawed plasma, RBCs, and antifibrinolytics are becoming more widely used. The Texas Trauma Institute in Houston has followed this progression by putting RBCs and thawed plasma in the emergency department and liquid plasma and RBCs on helicopters, transfusing platelets earlier, and using thromboelastogram-guided approaches. These changes have not only resulted in improved outcomes, but have also decreased inflammatory complications, operations, and overall use of blood products. In addition, studies have shown that resuscitating with plasma (instead of crystalloid) repairs the "endotheliopathy of trauma," or the systemic endothelial injury and dysfunction that lead to coagulation disturbances and inflammation. Data from the Trauma Outcomes Group, the Prospective Observational Multicenter Major Trauma Transfusion (PROMMTT) study, and the ongoing Pragmatic Randomized Optimal Platelet and Plasma Ratios (PROPPR) trial represent a decade-long effort to programmatically determine optimal resuscitation practices, balancing risk versus benefits. With injury as the leading cause of death in patients age 1 to 44 years and hemorrhage the leading cause of potentially preventable death in this group, high-quality data must be obtained to provide superior care to the civilian and combat injured.

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Lactated Ringer???s Solution and Hetastarch but Not Plasma Resuscitation after Rat Hemorrhagic Shock Is Associated with Immediate Lung Apoptosis by the Up-regulation of the Bax Protein

Cited by 82 publications

References 14 publications

Establishment of an Experimental Mouse Model of Trauma-Hemorrhagic Shock

Establishment of an Experimental Mouse Model of Trauma-Hemorrhagic Shock

Histologic changes of the fetal membranes after fetoscopic laser surgery for twin-twin transfusion syndrome

Optimal trauma resuscitation with plasma as the primary resuscitative fluid: the surgeon's perspective

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