Improved survival with early fluid resuscitation following hemorrhagic shock

Recent studies have questioned the benefits of early fluid resuscitation in hemorrhagic shock, The purpose of the current study is to evaluate the eff ects of early fluid resuscitation (HSE) (15 minutes), delayed fluid resusci tation (HSD) (60 minutes), and no fluid resuscitation (HSU) on cytokine lev els, hepatic resting membrane potential (Em), renal function, and mortality . Eighty male Sprague-Dawley rats (350-450 g) were hemorrhaged 35% of their total blood volume and then received 40, 80, or 100 mi of crystalloid per kilogram as intravenous fluids (IVFs), The implementation of HSE resulted i n stabilization of the Em (-29 mV), which was significantly different from that seen with HSD or HSU (-24 and -29 mV, respectively). The timing of res uscitation did not affect the elevation of tumor necrosis factor (TNF alpha ) levels. The interleukin-6 (IL-6) levels for the HSE group were 81, 101, a nd 274 pg/ml for 40, 80, and 100 ml/kg, respectively. In contrast. HSD grou p IL-6 levels were 440, 566, and 632 pg/ml for 40, 80, and 100 ml/kg (p < 0 .001). IL-6 levels for the HSU group was 427 pg/ml, which was significantly different from that of the HSE group (p < 0.05), Urine output was present in 58% of the HSE rats but only 24% in the HSD rats and 0% of the HSU rats. Mortality was 11% for HSE, 58% for HSD. and 50% for HSU rats, Despite the recent studies questioning the benefits of early fluid resuscitation, these data show marked improvement in hepatic stability, the presence of urine o utput, decreased IL-6 levels, and significantly lower mortality when IVFs w ere given early after hemorrhagic shock. Furthermore, excessive fluid resus citation (100 ml/kg) resulted in an increased inflammatory cytokine level a nd mortality and may account for the controversy.