Annals of Emergency Medicine
Volume 49, Issue 1 , Pages 37-44, January 2007

Delayed Fluid Resuscitation in Hemorrhagic Shock Induces Proinflammatory Cytokine Response

  • Chien-Chang Lee, MD, MSc

      Affiliations

    • Department of Emergency Medicine, National Taiwan University Hospital, and National Taiwan University, College of Medicine, Taipei, Taiwan
    • ,
  • I.-Jing Chang, MD

      Affiliations

    • Institute of Preventive Medicine, School of Public Health, National Taiwan University and Taipei City Hospital, Renai Branch, Taipei, Taiwan
    • ,
  • Zui-Shen Yen, MD, MPH

      Affiliations

    • Department of Emergency Medicine, National Taiwan University Hospital, and National Taiwan University, College of Medicine, Taipei, Taiwan
    • ,
  • Chiung-Yuan Hsu, MD

      Affiliations

    • Department of Emergency Medicine, National Taiwan University Hospital, and National Taiwan University, College of Medicine, Taipei, Taiwan
    • ,
  • Shey-Ying Chen, MD

      Affiliations

    • Department of Emergency Medicine, National Taiwan University Hospital, and National Taiwan University, College of Medicine, Taipei, Taiwan
    • ,
  • Chan-Ping Su, MD

      Affiliations

    • Department of Emergency Medicine, National Taiwan University Hospital, and National Taiwan University, College of Medicine, Taipei, Taiwan
    • ,
  • Wen-Chu Chiang, MD

      Affiliations

    • Department of Emergency Medicine, National Taiwan University Hospital, and National Taiwan University, College of Medicine, Taipei, Taiwan
    • ,
  • Shyr-Chyr Chen, MD, MBA

      Affiliations

    • Department of Emergency Medicine, National Taiwan University Hospital, and National Taiwan University, College of Medicine, Taipei, Taiwan
    • Corresponding Author InformationAddress for reprints: Shyr-Chyr Chen, MD, MBA, Department of Emergency Medicine, National Taiwan University Hospital and National Taiwan University, College of Medicine, No 7, Chung-Shan South Road, Taipei, Taiwan 100
    • ,
  • Wen-Jone Chen, MD, PhD

      Affiliations

    • Department of Emergency Medicine, National Taiwan University Hospital, and National Taiwan University, College of Medicine, Taipei, Taiwan

Received 9 January 2006; received in revised form 17 April 2006 and 4 May 2006; accepted 11 May 2006. published online 04 October 2006.

Study objective

This study is designed to determine the effects of delayed fluid resuscitation on the hemodynamic changes and cytokine responses in a rat model of hemorrhagic shock.

Methods

Wistar male rats (n=40; 8/group) were subjected to a volume-controlled hemorrhagic shock for 30 minutes and received lactated Ringer’s solution resuscitation as follows: (1) immediate resuscitation, (2) delayed resuscitation begun 30 minutes after hemorrhage (delayed resuscitation 30), (3) delayed resuscitation begun 45 minutes after hemorrhage (delayed resuscitation 45), (4) delayed resuscitation begun 60 minutes after hemorrhage (delayed resuscitation 60), or (5) unresuscitated group, induction of hemorrhagic shock without resuscitation. Hemodynamic parameters were recorded and blood samples were collected at 0 minutes and at 30, 90, 150, 210, 270, and 330 minutes after hemorrhage for plasma levels of interleukin (IL) 6, IL-10 and tumor necrosis factor α (TNF-α). Repeated-measurement analysis of variance was used for within- and between-groups comparisons.

Results

Final mean blood pressure, serum levels of lactate, and hematocrit levels after immediate resuscitation were not different from those in the delayed resuscitation groups. Comparing with the unresuscitated group, TNF-α and IL-6 concentrations were significantly higher, whereas IL-10 concentrations were significantly lower in the 4 resuscitation groups. Circulating concentrations of IL-6 were significantly higher in the delayed resuscitation 45 (P<.001) and delayed resuscitation 60 (P<.001) groups. Circulating concentrations of TNF-α and IL-10 in the 4 resuscitation groups were comparable throughout the experimental period.

Conclusion

Delayed fluid resuscitation in hemorrhagic shock induces increased production of proinflammatory cytokines, and the release of cytokine was correlated with the time delayed for resuscitation.

To access this article, please choose from the options below

Login to an existing account or Register a new account.

  • Purchase this article for 31.50 USD (You must login/register to purchase this article)

    Online access for 24 hours. The PDF version can be downloaded as your permanent record.

  • Subscribe to this title

    Get unlimited online access to this article and all other articles in this title 24/7 for one year.

  • Claim access now

    For current subscribers with Society Membership or Account Number.

  • Visit SciVerse ScienceDirect to see if you have access via your institution.
 

 Supervising editor: Stephen R. Thom, MD, PhDAuthor contributions: S-CC was the principal investigator and was responsible for the study design, managing and monitoring the study, and contributing to analysis and interpretation. C-CL wrote the article. C-CL, I-JC, Z-SY, C-YH, S-YC helped with design, analysis and interpretation of data, monitoring the study, and editing the article. C-PS, W-CC, and W-JC helped refine the study design, contributed to analysis and interpretation, and helped edit the article. S-CC takes responsibility for the paper as a whole.Funding and support: The authors report this study was supported by National Science Council grants NSC92-2314-002-282 and NSC90-2314-002-334.

PII: S0196-0644(06)01016-X

doi:10.1016/j.annemergmed.2006.05.031

Annals of Emergency Medicine
Volume 49, Issue 1 , Pages 37-44, January 2007

Article Tools

* Image Usage & Resolution