• Laura Boomer, Wright Jones, Brett Davis, Shelley Williams, and Annabel Barber.
• Department of Surgery, University of Nevada School of Medicine, Las Vegas, Nevada 89102, USA.
• Surg Infect (Larchmt). 2009 Oct 1; 10 (5): 379-87.

BackgroundRecent data suggest that the timing of fluid resuscitation and the type of fluid used to treat hemorrhagic shock contribute to the inflammatory response as well as cell death.MethodsRats were bled of 40% of their total blood volume and then resuscitated in either early or delayed fashion. Treatment was assigned randomly and consisted of lactated Ringer's solution, normal saline, bicarbonate Ringer's solution, hypertonic saline, or no resuscitation. The first four groups were subdivided into early and late resuscitation. After a 5-h observation period, lung and liver samples were evaluated for apoptosis, and blood was collected for measurements of the cytokines interleukin (IL)-6, IL-10, and IL-1beta.ResultsThe rats that were not resuscitated had significantly more apoptosis in liver tissue. In the lung, bicarbonate Ringer's solution, when given early, was associated with significantly less apoptosis. Non-resuscitated rats had significantly higher IL-6 concentrations than all other groups. Animals receiving hypertonic saline early had significantly higher IL-6 concentrations than those given any other fluid. The concentration of IL-1beta was significantly higher in the non-resuscitated rats than in those receiving bicarbonate Ringer's, lactated Ringer's, or normal saline for early resuscitation. Interleukin-10 was elevated significantly in non-resuscitated rats.ConclusionsCellular destruction and a pro-inflammatory response follow hemorrhagic shock. Early resuscitation with isotonic crystalloid fluids decreases these responses.

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