Resuscitation of traumatic brain injury and hemorrhagic shock with polynitroxylated albumin, hextend, hypertonic saline, and lactated Ringer's: Effects on acute hemodynamics, survival, and neuronal death in mice

Outcome after traumatic brain injury (TBI) is worsened by hemorrhagic shock (HS), but the optimal resuscitation approach is unclear. In particular, treatment of TBI patients with colloids remains controversial. We hypothesized that resuscitation with the colloids polynitroxylated albumin (PNA) or He...

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Bibliographic Details
Published in:	Journal of neurotrauma Vol. 26; no. 12; p. 2403
Main Authors:	Exo, Jennifer L, Shellington, David K, Bayir, Hülya, Vagni, Vincent A, Janesco-Feldman, Keri, Ma, Lil, Hsia, Carleton J, Clark, Robert S B, Jenkins, Larry W, Dixon, C Edward, Kochanek, Patrick M
Format:	Journal Article
Language:	English
Published:	United States 01-12-2009
Subjects:	Albumins - pharmacology Albumins - therapeutic use Animals Blood Volume - drug effects Blood Volume - physiology Brain - drug effects Brain - pathology Brain - physiopathology Brain Injuries - drug therapy Brain Injuries - physiopathology Cell Count Disease Models, Animal Emergency Medical Services - methods Hemodynamics - drug effects Hemodynamics - physiology Hippocampus - drug effects Hippocampus - pathology Hippocampus - physiopathology Hydroxyethyl Starch Derivatives - pharmacology Hydroxyethyl Starch Derivatives - therapeutic use Hypotension - drug therapy Hypotension - physiopathology Isotonic Solutions - pharmacology Isotonic Solutions - therapeutic use Male Mice Mice, Inbred C57BL Nerve Degeneration - drug therapy Nerve Degeneration - physiopathology Nerve Degeneration - prevention & control Oxidative Stress - drug effects Oxidative Stress - physiology Resuscitation - methods Ringer's Lactate Saline Solution, Hypertonic - pharmacology Saline Solution, Hypertonic - therapeutic use Shock, Hemorrhagic - drug therapy Shock, Hemorrhagic - etiology Shock, Hemorrhagic - physiopathology Survival Rate Treatment Outcome
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Summary:	Outcome after traumatic brain injury (TBI) is worsened by hemorrhagic shock (HS), but the optimal resuscitation approach is unclear. In particular, treatment of TBI patients with colloids remains controversial. We hypothesized that resuscitation with the colloids polynitroxylated albumin (PNA) or Hextend (HEX) is equal or superior to resuscitation with the crystalloids hypertonic (3%) saline (HTS) or lactated Ringer's solution (LR) after TBI plus HS in mice. C57/BL6 mice (n = 30) underwent controlled cortical impact (CCI) and 90 min of volume-controlled HS (2 mL/100 g). The mice were randomized to resuscitation with LR, HEX, HTS, or PNA, followed by 30 min of test fluid administration targeting a mean arterial pressure (MAP) of >50 mm Hg. Shed blood was re-infused to target a MAP >70 mm Hg. At 7 days post-insult, hippocampal neuron counts were assessed in hematoxylin and eosin-stained sections to quantify neuronal damage. Prehospital MAP was higher, and prehospital and total fluid requirements were lower in the PNA and HEX groups (p < 0.05 versus HTS or LR). Also, 7-day survival was highest in the PNA group, but was not significantly different than the other groups. Ipsilateral hippocampal CA1 and CA3 neuron loss did not differ between groups. We conclude that the colloids PNA and HEX exhibited more favorable effects on acute resuscitation parameters than HTS or LR, and did not increase hippocampal neuronal death in this model.
ISSN:	1557-9042
DOI:	10.1089/neu.2009.0980