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Resuscitation Fluids and Endotoxin-Induced Myocardial Dysfunction: is Selection a Load-Independent Differential Issue?
MedLine Citation:
PMID:  22777110     Owner:  NLM     Status:  Publisher    
Along with redistributive shock, myocardial dysfunction is now recognized as highly prevalent in early severe sepsis. Indeed, aside from their distinct loading potency, resuscitation fluids have been poorly investigated as to their specific molecular impact on myocardial dysfunction. OBJECTIVE: to evaluate the load-independent biological impact of different resuscitation fluids on endotoxin-induced myocardial dysfunction. DESIGN: Adult rats implanted with a central venous catheter were given an intraperitoneal injection of endotoxin (lipopolysaccharides [LPS], E coli, 10mg/kg) or normal saline (sham), and subsequently infused or not with similar "fluid potency" loading resuscitation fluid (normal saline [NS], Albumin [Alb], or hypertonic saline solution [HSS]) for 6 to 24hrs, followed by echocardiographic and hemodynamic monitoring together with biochemical and histopathological evaluation. INTERVENTION: To assess the selective influence of load-independent fluid infusion on the aforementioned parameters in groups of animals challenged or not with LPS. RESULTS: At comparative plasma volumes, Alb improved myocardial homeostasis after LPS challenge by i) reducing left ventricular relative wall diastolic thickness (LVRWD); interstitial space enlargement and endogenous albumin content, ii) limiting cardiac apoptosis and sustaining extracellular signal-regulated Mitogen Activated Protein Kinase [ERK1-2 MAPK] activation, and iii) enhancing the expression pattern of heme-oxygenase-1/inducible NO synthase. HSS was also cardioprotective by early prevention of myocardial dysfunction and by reducing cardiac apoptosis. CONCLUSION: Fluid infusions have distinct load-independent structural/biological impacts on endotoxin-induced myocardial dysfunction. Alb and HSS are the most pleiotropic fluids in protecting the heart after a "sepsis" hit.
Bruno Hogue; Frederic Chagnon; Olivier Lesur
Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-7-6
Journal Detail:
Title:  Shock (Augusta, Ga.)     Volume:  -     ISSN:  1540-0514     ISO Abbreviation:  -     Publication Date:  2012 Jul 
Date Detail:
Created Date:  2012-7-10     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9421564     Medline TA:  Shock     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
1Soins intensifs médicaux, département de Médecine, 2Centre de recherche clinique Étienne-Lebel (CRCEL) CHUS, Université de Sherbrooke, Québec, Canada.
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