EFFECTS OF HYDROXYETHYL STARCH AFTER TRAUMA-HEMORRHAGIC SHOCK - RESTORATION OF MACROPHAGE INTEGRITY AND PREVENTION OF INCREASED CIRCULATINGINTERLEUKIN-6 LEVELS

Objectives: To determine the effects of resuscitation with the colloid al solution (hydroxyethyl starch) vs. crystalloid solution on cell-med iated immune functions after trauma-hemorrhage. Design: Prospective, m ultiexperimental, randomized, controlled study. Setting: University re search laboratory. Subjects: Thirty-six inbred male C3H/HEN (endotoxin -sensitive) mice, aged 6 to 7 wks, and weighing 18 to 23 g. Interventi ons: Crystalloid (lactated Ringer's solution) with and without 6% hydr oxyethyl starch after trauma-hemorrhage. Measurements and Main Results : Mice underwent laparotomy, were bled to and maintained at a blood pr essure of 40 mm Hg for 60 mins, then resuscitated with either 4x the s hed blood volume as lactated Ringer's solution or 2x the shed blood vo lume as lactated Ringer's solution plus 1x 6% hydroxyethyl starch, Sha m mice were neither hemorrhaged nor resuscitated. At 2 or 24 hrs posth emorrhage, serum, splenocytes, peritoneal macrophages, and splenic mac rophages were obtained. Bioassays were used to determine interleukin-2 , interleukin-3, and interleukin-6 concentrations, while splenocyte pr oliferation was assessed by H-3-thymidine incorporation. Trauma-hemorr hage markedly depressed splenocyte proliferation, interleukin-6 releas e by macrophages, and lymphokine release at 2 and 24 hrs postresuscita tion. The combination of lactated Ringer's solution and hydroxyethyl s tarch neither restored, nor exacerbated lymphocyte functions, Interleu kin-6 release by peritoneal macrophages was restored 24 hrs after hydr oxyethyl starch infusion; serum interleukin-6 concentrations remained at sham levels. Conclusions: Since the use of lactated Ringer's soluti on and hydroxyethyl starch after hemorrhage did not adversely affect c ell-mediated immune functions, but produced salutary effects on macrop hage functions, hydroxyethyl starch is a safe and beneficial resuscita tion adjunct.