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

Abstract

Background: Hemorrhagic 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.Methods: Landrace 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. Results:The 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.Conclusions: Compared 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.

Effect of sodium bicarbonate Ringer's solution on lung injury in rats with traumatic hemorrhagic shock

“…[ 32 ] Inflammatory responses can lead to glycocalyx destruction and increase vascular permeability. [ 33 ] This study indicated that LRS increased the levels of SDC and HPA, while BRS only increased the level of SDC in lung tissues. Moreover, acidic resuscitation environment at pH6.5 aggravated glycocalyx damage, while an alkaline recovery environment at pH8.1 had no significant effect.…”

A bibliometric analysis of publications on trauma-related hemorrhagic shock from 2012 to 2022: Research landscape and future trends

“…[ 42 ] Early transfusion of plasma and balanced transfusion have been shown to restore the endothelial glycocalyx. [ 44 ] Early tranexamic acid administration [ 45 ] and restrictive resuscitation [ 46 ] have also shown protective effects against glycocalyx degradation in vitro.…”

Endothelial glycocalyx in hepatopulmonary syndrome: An indispensable player mediating vascular changes

“…However, the pulmonary circulation is relatively tolerant to hemodynamic changes due to its low resistance. This may be protective to pulmonary eGCX, the preservation of which may prevent subsequent insults to the endothelium integrity and reduce the frequency interstitial edema ( 73 , 74 ). Contrarily, the pulmonary eGCX under this condition may exacerbate IPVD by sensing the increased shear stress and elevating NO release, although this remains to be specifically elucidated in human studies.…”