Fluid Resuscitation Aggravates the Cellular Injury in a Hemorrhagic Shock Model


Vardar K., Can K., Aksu U.

DUBAI MEDICAL JOURNAL, cilt.5, sa.2, ss.141-150, 2022 (Hakemli Dergi) identifier

  • Yayın Türü: Makale / Tam Makale
  • Cilt numarası: 5 Sayı: 2
  • Basım Tarihi: 2022
  • Doi Numarası: 10.1159/000520430
  • Dergi Adı: DUBAI MEDICAL JOURNAL
  • Derginin Tarandığı İndeksler: EMBASE, Directory of Open Access Journals
  • Sayfa Sayıları: ss.141-150
  • Anahtar Kelimeler: 0, 9% NaCl, Hydroxyethyl starch, Kidney, Hemorrhagic shock, Resuscitation, ENDOTHELIAL GLYCOCALYX, OXIDATIVE STRESS, CATALYTIC IRON, RENAL-FUNCTION, OXYGENATION, HEMOGLOBIN, ISCHEMIA, ALBUMIN, MARKER, INDEX
  • İstanbul Üniversitesi Adresli: Evet

Özet

<b><i>Background:</i></b> Resuscitation is the initial step for hemorrhagic shock. However, there is still controversy as to which fluid achieves the best results clinically and experimentally. <b><i>Aim:</i></b> It was aimed to investigate the effects of 0.9% NaCl (sodium chloride) and 6% HES (hydroxyethyl starch) on the kidney and blood environment. <b><i>Methods:</i></b> Twenty-four male Wistar rats were assigned as control, shock, and resuscitated (colloid: 6% HES and crystalloid: 0.9% NaCl) groups. Besides hemodynamics (mean arterial pressure and shock index) monitoring and kidney function evaluation, hemolysis, oxidative stress, inflammation, and glycocalyx degradation were evaluated in the plasma and kidney. <b><i>Results:</i></b> (1) Macrohemodynamics were successfully restored by both fluids. (2) Although 3 times more crystalloid volume was applied compared to the colloid resuscitation, similar hematocrit levels were found in both resuscitation strategies (32.8 ± 2.3 vs. 33.3 ± 1.0). (3) NaCl resuscitation led to increases in the hemolytic index, catalytic iron, and sialic acid compared to control, while HES administration increased the levels of malondialdehyde, ischemia-modified albumin, and sialic acid. (4) However, both fluid resuscitation strategies could inhibit inflammation and oxidative stress in the kidney and restore kidney function parameters. <b><i>Conclusion:</i></b> Although both NaCl and HES resuscitation showed protection of the kidney function against oxidative stress and inflammation, these fluids initiated the injury process.