Supplementary Administration of Serum Protein Solution during Shock Resuscitation in the Rat

Abstract

European Journal of TraumaAb stract Background and Purpose: Hemorrhagic shock initiates an inflammatory response that leads to microcirculatory disturbances. Resuscitation with crystalloids and colloids may restore mean arterial blood pressure but does not specifically inhibit inflammatory cascades. In this study, a serum protein solution (SPS) was administered during shock resuscitation in order to investigate hepatic microcirculation following hemorrhagic shock. The effect of this SPS was compared with two other substances, albumin and gelatine. Material and Methods: Using an animal model, hemorrhagic shock was induced in 36 rats for 60 min at 40 mmHg. Afterwards, resuscitation was started with either gelatine (3%), human serum albumin (5%), SPS consisting of albumin and globulins (5%), a combination of gelatine/albumin (1 : 1), or a combination of gelatine/SPS (1 : 1). After a resuscitation period of 6 h, the hepatic microcirculation, leukocyte-endothelium interaction and sinusoidal width were examined using intravital microscopy. Results: Values for hemoglobin, platelets, white blood cells and base deficit did not differ between the groups. In contrast to albumin and SPS, gelatine restored mean arterial blood pressure most effectively. In addition, the combination of SPS/gelatine attenuated permanent leukocyte adhesion significantly. Except for the SPS group, erythrocyte blood flow in the liver was significantly reduced in all shock groups. Conclusion: While gelatine is most effective in the restoration of the systemic circulation, the addition of SPS might allow nonspecific attenuation of leukocyte adhesion in the liver. Moreover, SPS might improve the reduced erythrocyte blood flow after hemorrhagic shock.

Searching For the Optimal Fluid to Restore Microcirculatory Flow Dynamics After Haemorrhagic Shock

“…A number of studies have proposed that small volume resuscitation with hypertonic-hyperosmotic solutions may affect the flow behaviour of leucocytes and reduce their stagnation (40), margination (22), rolling(67) and adhesion to the endothelium(81), as well as attenuating the number of endothelium-leukocyte interactions (23,66,90). Reduction of leucocyte adhesion has also been reported when using gelatine serum protein solutions as a resuscitative fluid (57).…”