The capacity of different infusion fluids to lower the prooxidant activityof plasma iron: an important factor in resuscitation?

BACKGROUND: Prooxidant activity of non-protein-bound iron (NPBI) is an impo rtant contributor to reactive oxygen species-induced injury after the resus citation of critically ill patients. Plasma NPBI occurs in critically ill a dults, children, and newborn babies, who often require resuscitation. The a bility of the resuscitation fluids to bind iron and lower the patients' NPB I levels in vitro has not previously been studied. STUDY DESIGN AND METHODS: In an in vitro model, highly iron-saturated cord blood plasma from 10 preterm and 10 term babies was mixed with FFP pasteuri zed plasma protein solution, and 0.9-percent saline. Plasma from 10 healthy adult volunteers was used as a control. Before and after the mixing with a ny resuscitation fluid, NPBI levels and ceruloplasmin iron-oxidizing and tr ansferrin iron-binding antioxidant capacities were measured. RESULTS: After the in vitro mixing with FFP, the incidence and concentratio n of NPBI were markedly decreased and the iron-binding antioxidant capacity was increased in the plasma of the preterm and term,babies. Being mixed wi th pasteurized plasma protein solution and 0.9-percent saline did not influ ence the iron-binding antioxidant capacity of newborn babies' plasma. In th e control plasma, results were not changed after the mixing with any resusc itation fluid. In every group, the iron-oxidizing antioxidant capacity was not changed after the mixing with any fluid. CONCLUSION: Iron-induced oxidative tissue damage may be influenced by resus citation fluids. In the ongoing debate over the choice of crystalloid or co lloid resuscitation fluids, the influence of each fluid on the patient's an tioxidant capacity warrants more attention.