Hypertonic Saline Resuscitation Restores Inflammatory Cytokine Balance in Post-Traumatic Hemorrhagic Shock Patients

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Authors
  1. Rhind, S.G.
  2. Rizoli, S.B.
  3. Shek, P.N.
  4. Inaba, K.
  5. Filips, D.
  6. Tien, H.
  7. Brenneman, F.
  8. Rotstein, O.D.
Corporate Authors
Defence R&D Canada - Toronto, Toronto ONT (CAN)
Abstract
Fluid resuscitation can often exacerbate injury sustained during hemorrhagic shock and is associated with altered immuno-inflammatory events. Early monocyte dysregulation and excessive proinflammatory cytokine production are thought to play a key role in the development of post-traumatic multiorgan dysfunction in resuscitated trauma patients. Compared with standard isotonic crystalloid resuscitation using 0.9% normal saline (NS), 7.5% hypertonic saline with 6% dextran-70 (HSD) has been shown in experimental studies to reduce shock/resuscitation-induced inflammatory reactions and lessen organ dysfunction. However, the immunomodulatory capacity of HSD, has not been evaluated in clinical human trials. In this prospective, randomized controlled trial we show that a single (250 mL) bolus infusion of HSD in hemorrhagic trauma patients restores the balance between pro and antiinflammatory mediators in the early post-resuscitative period. Flow cytometric single-cell analyses revealed that, compared to standard resuscitation with NS, which selectively expands the proinflammatory CD14+CD16+ monocyte phenotype, initial treatment with HSD elicits selective depletion of CD14+CD16+ cells and down-regulates monocytic adhesion molecule expression. Moreover, HSD significantly inhibits intracellular TNF-a production by CD14+CD16+ monocytes, while upregulating both IL-10 and IL-1ra by CD14++CD16– monocytes. This differential profile of monocytic cytokine expression in response to HSD appears

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Keywords
hemorrhagic shock, immune, cytokine, trauma, fluid resuscitation, hypertonic sal
Report Number
DRDC-TORONTO-SL-2004-099;RTO-MP-HFM-109 — Scientific Literature
Date of publication
16 Aug 2004
Number of Pages
24
Reprinted from
Published in NATO RTO-MP-HFM-109 proceedings, August 2004, Pages 1-1 to 1-24
DSTKIM No
CA025864
CANDIS No
523626
Format(s):
Electronic Document(PDF)

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