Long-term safety and efficacy of programmable implantable insulin delivery systems

OBJECTIVES

Since only short-term studies of continuous intraperitoneal insulin infusion (CIPII) therapy using implantable programmable insulin delivery systems have been performed to show this method of diabetes therapy to be safe and efficacious, we have performed long-term studies to assess its safety and efficacy.

RESEARCH DESIGN AND METHODS

For 78 patient-years of follow-up, we have longitudinally studied the incidence of diabetic ketoacidosis and severe hypoglycemia in 25 type 1 diabetic patients treated with CIPII. We also compared, cross-sectionally, the long-term safety and efficacy of CIPII to intensive subcutaneous insulin therapy using intermittent injections or continuous subcutaneous insulin infusion. Finally, we examined the relationship between glycated hemoglobin levels and the standard deviation of daily blood glucose excursion.

RESULTS

Cross-sectional analysis revealed similar degrees of metabolic control accompanied by significantly decreased rates of both ketoacidosis (0.013 events/patient/year) and severe hypoglycemia (0.05 events/patient/year) during CIPII compared to intermittent injections and continuous subcutaneous insulin infusion therapy. A four-fold decrease in the rate of severe hypoglycemia was observed during longitudinal comparison of pre- and post-implantation complication rates. A relationship was also shown between decreased levels of mean glycated hemoglobin and the standard deviation of blood glucose excursions during CIPII therapy.

CONCLUSIONS

Our data demonstrate that long-term therapy with CIPII is as effective as other methods in achieving near-normal levels of glycated hemoglobin, which in CIPII is associated with a decreased standard deviation of blood glucose excursions. Further, CIPII using implantable programmable insulin delivery systems is the safest method described for intensive insulin therapy in home blood glucose monitoring type 1 diabetic patients.

Superoxide dismutase and allopurinol improve survival in an animal model of hemorrhagic shock

We studied the efficacy of resuscitation with antioxidants in an animal model of hemorrhagic shock. Male Sprague-Dawley rats were anesthetized, and 27 mL/kg of blood was withdrawn from the carotid artery over 2 minutes. The animals remained in hemorrhagic shock for 45 minutes, followed by 1 hour of resuscitation. Experimental groups were as follows: 1) 15,000 u/kg superoxide dismutase (SOD) in 54 mL/kg lactated Ringer (LR); 2) 175,000 u/kg catalase (CAT) in LR; 3) 15,000 u/kg SOD+175,000 u/kg CAT in LR; 4) allopurinol in LR; 5) deferoxamine bound to pentafraction (DFO), 27 mL/kg; 6) pentafraction alone; and 7) LR alone. Compared with resuscitation with LR alone, SOD and allopurinol improved survival over 72 hours, P < 0.05. Survival with SOD+CAT was not different from LR alone. Deferoxamine bound to pentafraction did not increase survival over that with pentafraction alone. CAT had increased mortality compared to LR, P < 0.01. The efficacy of both SOD and allopurinol in decreasing mortality suggests the importance of superoxide radicals after hemorrhagic shock and resuscitation. These and other antioxidants are potential therapeutic agents in the clinical setting of trauma and hemorrhagic shock.

Continuous arteriovenous hemodiafiltration in postoperative and traumatic renal failure

Management of acute renal failure (ARF) in surgical patients has relied on supportive measures including hemodialysis and peritoneal dialysis. An alternative technique currently available is continuous arteriovenous hemodiafiltration (CAVH-D). Records of 44 surgical patients with ARF who were treated with CAVH-D in our surgical intensive care unit from 1989 to 1992 were reviewed. Thirty-five patients underwent emergency operations, and 4 patients underwent elective operations. Thirty-three patients were hemodynamically unstable immediately prior to the institution of CAVH-D, making hemodialysis a contraindication. A total of 565 CAVH-D days with an average of 13 days per patient were evaluated. Seventeen patients survived, with recovery of renal function in 13 patients. Vascular access was obtained via 227 percutaneous femoral catheters and 4 Scribner shunts. Seven vascular complications occurred, including arteriovenous fistula, pseudoaneurysm, limb ischemia, femoral artery hemorrhage, and femoral vein thrombosis. Based on these data, we conclude that CAVH-D is a safe and effective alternative in surgical patients with ARF.

Emergency thoracotomy with lung resection following trauma

Over a 7-year period, 9443 trauma patients were evaluated with 2934 (31%) sustaining chest trauma. Of these, 347 (12%) patients required thoracotomy, with 12 patients undergoing emergency lung resection. Mean age was 23.1 years with mean Injury Severity Score of 32. Mechanism of injury was blunt in three (25%), gunshot wound in seven (58%), and stab wound in two (17%). Associated injuries included head injury in two (17%), intra-abdominal injury requiring laparotomy in four (33%), cardiac injury in three (25%), and great vessel injury in one (8%). Indications for operation included persistent hemorrhage in 11 and suspected tracheobronchial disruption in one. Non-anatomic lung resection was performed in five patients, lobectomy in three patients, and pneumonectomy in four patients. Overall mortality was 33 per cent: 20 per cent for non-anatomical lung resection, 33 per cent for lobectomy, and 50 per cent for pneumonectomy. All survivors fully recovered except for one patient with an associated head injury. Our experience supports the selective use of lung resection, including pneumonectomy, to immediately control hemorrhage and to impact survival in severe chest trauma.

Pentoxifylline alone versus pentoxifylline combined with superoxide dismutase prolongs survival in a rat hemorrhagic shock model

Pentoxifylline (PTX) and superoxide dismutase (SOD) have each proven effective in improving survival when administered during resuscitation in animal models of hemorrhagic shock. This study was conducted to determine if PTX and SOD combined would have synergistic effectiveness in the treatment of hemorrhagic shock. Sprague-Dawley rats (n = 40) were phlebotomized at 25 ml/kg for 2 min, then subjected to a 45-min ischemic period, and resuscitated with lactated Ringer's solution (LR) (50 ml/kg) over 1 h. This model resulted in 70% mortality over 72 h when resuscitation was with LR alone. Animals were randomized into groups to receive one of the following agents during resuscitation: PTX in LR, SOD in LR, a combination of PTX and SOD in LR, or LR alone. PTX or SOD alone were effective in prolonging survival. However, the combination of PTX and SOD did not prolong survival above LR control.

Absorption of insulin in the peritoneal cavity in a diabetic animal model

This study was conducted to determine if different anatomical sites within the peritoneal cavity have different capacities for portal insulin absorption. Diabetic male Sprague-Dawley rats were studied. They were anesthetized and injected with streptozotocin. Blood glucose was measured before and after insulin (1 U/kg) was applied directly to the omentum, serosal surface of cecum, or parietal peritoneum or injected subcutaneously. In a control group, blood glucose was measured at intervals without administering insulin. In addition, insulin labeled with radioactive iodine (125I) was applied to the same three locations in the peritoneal cavity or injected intravenously. Animals were sacrificed at 1, 5, 15, or 30 mins, and radioactivity was measured in excised livers and in blood samples. Blood glucose in the omental group responded to insulin with a greater hypoglycemic effect than in the peritoneal and control groups. The percentage of radioactivity recovered in liver was significantly higher in the omental than in the serosal and peritoneal groups at 1 and 5 mins. The ratio of liver-to-blood radioactivity was also significantly higher in omental than in serosal and peritoneal groups and higher in the serosal than in the peritoneal group at 5 mins. The data suggest that, in this model, the omentum is a better site for insulin absorption than serosa or parietal peritoneum and that significant portal venous absorption of insulin occurs.

Vascular complications of continuous arteriovenous hemofiltration in trauma patients

Continuous arteriovenous hemofiltration (CAVH) has recently become useful in the treatment of acute renal failure following trauma. It allows continuous volume removal and avoids the acute hemodynamic changes often seen with hemodialysis. To determine the risks of CAVH catheters, the records of trauma patients undergoing CAVH from August 1989 through May 1992 were reviewed. Of 4685 trauma patients, 29 developed renal failure requiring dialysis, with 26 managed with CAVH. Vascular access was obtained via 126 percutaneous 8F femoral arterial and venous catheters (64 arterial, 62 venous) and four Scribner shunts. There was a total of 309 CAVH-D days, with an average of 11.9 days per patient. Complications included one femoral arteriovenous fistula, one pseudoaneurysm, and one deep venous thrombosis, resulting in a 3.1% (2 of 64) arterial complication rate and a 1.6% (1 of 62) venous complication rate. The incidence of arterial complications compares with that of angiography, but complications were major and required surgery. Alternative techniques such as continuous venovenous hemofiltration may prove beneficial.

Orotracheal intubation in trauma patients with cervical fractures

OBJECTIVE

To evaluate orotracheal intubation with in-line stabilization of the cervical spine for emergency airway treatment of trauma patients with cervical spine injuries.

DESIGN

Of 7518 trauma patients examined, 81 patients with cervical spine injuries received emergency orotracheal intubation. All intubations were performed by experienced anesthesiologists, with a separate individual maintaining in-line stabilization. Neurologic examination was documented before and after intubation.

RESULTS

Peripheral neurologic deficit was present from the outset in 20 patients. There were unstable cervical fractures in 38 patients with no neurologic deficit. Twenty-three patients were neurologically intact with fractures that were later judged stable. In no instance was there a deterioration of neurologic status following intubation. Peripheral neurologic deficits improved after intubation in four patients.

CONCLUSION

Orotracheal intubation, performed with manual in-line stabilization by trained and experienced personnel, is a safe emergency procedure in patients with cervical fractures.

Tumor necrosis factor and monocytes are released during hemorrhagic shock

Tumor necrosis factor (TNF) is a key mediator involved in many physiologic processes including immunity, inflammation, and metabolism. A relationship between TNF and hemorrhagic shock has not been clearly demonstrated. To help understand the role of TNF in hemorrhagic shock we developed a hemorrhagic shock model to measure TNF and monocyte levels during hemorrhage and resuscitation. Male Sprague-Dawley rats were anesthetized and subjected to a 50% blood loss (30 ml/kg) over 2 min and left in shock for 58 min. The animals were then resuscitated with two times blood loss (60 ml/kg) using lactated Ringers over 1 h. This model results in 75% mortality within 3 days (LD 75). Blood samples (2 ml) were obtained at intervals during shock and resuscitation, and assayed for TNF concentrations and white blood cell counts. Despite a marked fall in total leukocytes (24,600 pre-hemorrhage to 11,300 post-hemorrhage, P < 0.005), monocytes increased in percentage and in total count. Blood levels of TNF were initially undetectable but rose within 10 min after hemorrhage, peaked at 30 min after hemorrhage, and then became undetectable during resuscitation. In this model, macrophages and TNF are released into the circulation after hemorrhagic shock. TNF may play a role as a mediator in the pathophysiology of hemorrhagic shock.

Trauma causes early release of soluble receptors for tumor necrosis factor

The importance of tumor necrosis factor (TNF) in the pathophysiology of trauma and hemorrhagic shock is not known. In addition, TNF bioactivity may be modulated by soluble forms of the 55-kd and 75-kd membrane receptors (TNFR). This study was undertaken to determine circulating levels of TNF and TNFR after trauma. Nine severely injured male patients were studied. The mean age was 30 +/- 10 years (range, 15-45). The mean Injury Severity Score (ISS) was 31.3 +/- 17.6 (range, 10-59), and the mean Revised Trauma Score (RTS), 5.7 +/- 2.2 (range, 0.7-7.8). Serum was obtained immediately upon arrival at our trauma center, within 1 hour of injury. The TNF and TNFR levels in the serum were measured using ELISA techniques. After trauma, 55-kd and 75-kd TNFR levels were significantly elevated above those of controls (6.99 +/- 4.57 ng/mL and 5.42 +/- 1.88 ng/mL, respectively, p < 0.01); TNF levels were not increased. Patient serum containing TNFR inhibited in vitro TNF cytotoxicity and correlated with 55-kd TNFR levels (p < 0.05). We conclude that TNF is a strong releasing factor for TNFR; the presence of TNFR may be indirect evidence that TNF is present after trauma, despite low measured levels. Both TNF and TNFR may be more important in trauma and hemorrhagic shock than previously thought.

Hypoxia induces a human macrophage cell line to release tumor necrosis factor-alpha and its soluble receptors in vitro

Tissue hypoxia following hemorrhage and trauma is a possible initiating factor of the generalized inflammatory response seen after shock. The role of hypoxia in the release from a human monocyte cell line (THP-1) of tumor necrosis factor-alpha (TNF alpha) and its soluble membrane receptors (TNF alpha R) in-vitro is investigated in this study. Flat-bottom plates with 500,000 THP-1 cells/ml were placed in air-tight sealed boxes and exposed to hypoxia (O2 = 1%) or controls (O2 = 9%) for up to 24 hr. Supernatants were tested for TNF alpha, as well as 55- and 75-kDa soluble receptors for TNF alpha, by ELISA. Cell viability was assessed by vital dye uptake and was found to be maintained throughout hypoxic exposure. Medium pH levels were within normal range. In eight experiments conducted in duplicate, minimal change over 24 hr occurred in control samples. Control mean and SD were: TNF alpha = 12.0 +/- 4.2, 55-kDa R = 34.6 +/- 2.03, and 75-kDa R = 38.88 +/- 9.68 pg/ml. During hypoxia, TNF alpha was released as early as the first 30 min of exposure (41.3 +/- 2.3 pg/ml) with a small peak at 1 hr (52 +/- 5.0 pg/ml) and a later more pronounced peak at 18 hr (526 +/- 48 pg/ml). Both 55- and 75-kDa R were released by the hypoxic monocytes; release was progressive and was maximal at 24 hr in this study. Maximal release value of 55-kDa R was 236 +/- 15 pg/ml, while for 75-kDa R it was 2450 +/- 63 pg/ml.(ABSTRACT TRUNCATED AT 250 WORDS)

Occult traumatic pneumothorax: immediate tube thoracostomy versus expectant management

Occult pneumothorax is pneumothorax identified by computed tomography but not seen on conventional chest radiographs. Twenty-seven occult traumatic pneumothoraces in 26 patients were identified retrospectively at the authors' level I trauma center. Of these, 24 patients survived to discharge or transfer; 2 died of brain injury. Eleven patients were treated immediately with tube thoracostomy (TT) and 13 were observed with interval chest radiography. The authors' data support the conclusion that it is safe to withhold immediate TT in patients who are hemodynamically stable. Close clinical observation and interval chest radiography can identify those patients who require subsequent TT. Prospective study of larger numbers of patients is needed to confirm the safety and cost efficacy of this approach.

Implantable programmable insulin pumps for the treatment of diabetes

Implantable programmable pump systems for insulin delivery to the peritoneal cavity or for intravenous insulin delivery have been recently developed. Thirty-one pumps were implanted in 25 patients between 1987 and 1991. At this writing, 76% of patients had functioning pumps. Ninety-two percent of pumps were functioning at 1 year; 89% at 2 years; and 50% at 3 years. No life-threatening complications, either surgical or metabolic, developed. However, 18 patients required 23 outpatient procedures for maintenance of pump function or for pump removal. Metabolic improvement was evidenced by mean and standard deviation of blood glucose levels and by glycosylated hemoglobin levels.

Diagnosis of myocardial contusion. Quantitative analysis of single photon emission computed tomographic scans

Prior studies from our institution have shown that single photon emission computed tomography is sensitive (100%) in predicting patients at risk for serious arrhythmias. However, the positive predictive value is low (15% to 20%). The purpose of this study was to determine if quantitative analysis of single photon emission computed tomographic defects could improve predictive value. One hundred seventy-five patients with positive single photon emission computed tomographic scans were studied. One hundred two patients developed arrhythmias, 42 of which were ventricular. Arrhythmias were associated with all defect loci and all defect sizes. The incidence of arrhythmias did increase with increasing size. Patients were at risk for arrhythmias up to 72 hours after trauma. The value of single photon emission computed tomography is its ability to predict patients at risk for arrhythmias. This study shows that any single photon emission computed tomographic defect, regardless of location or size, is a significant predictor of arrhythmias.

Safety and efficacy of glycerol and amino acids in combination with lipid emulsion for peripheral parenteral nutrition support

The safety and efficacy of administering lipid emulsion with ProcalAmine, a glycerol-based parenteral nutrition solution, for peripheral nutrition has not been previously studied. Thirty-four patients recovering from major trauma or surgery were studied while receiving a peripheral parenteral nutrition regimen of either ProcalAmine with 10% lipid emulsion (group 1) or ProcalAmine with 20% lipid emulsion (group 2) for up to 5 days postinjury. Daily dose was 45 mL/kg ProcalAmine, providing 1.35 g of amino acids/kg and 1.35 g of glycero/kg, and 500 mL/day lipid emulsion. The mean daily nitrogen balance was -0.3 g/day in group 1 and -4.1 g/day in group 2. There was no progressive accumulation of circulating glycerol, and urinary glycerol excretion was minimal (less than 0.2 g/day), indicating effective utilization of glycerol as an energy substrate. Our finding that nitrogen balance was better with 10% fat emulsion suggests a limitation in fat utilization in this setting. Both regimens were well tolerated; there were no adverse clinical reactions and no occurrences of phlebitis in either group.

Regional flow during experimental hemorrhage and crystalloid resuscitation: persistence of low flow to the splanchnic organs

BACKGROUND AND METHODS. Rapid changes in cardiac output (CO) and organ perfusion occur with hemorrhagic shock and fluid resuscitation. To assess regional alterations of flow, 40 Sprague-Dawley male rats were subjected to hemorrhagic shock and crystalloid resuscitation under halothane anesthesia. Polyethylene microspheres were injected before and after hemorrhage and after resuscitation. At sacrifice, brain, lungs, heart, liver, intestine, spleen and kidneys were harvested, weighed and radioactivity counted. Changes in mean arterial pressure, oxygen consumption, organ flow and CO were also measured.

RESULTS

Cardiac output decreased during hemorrhage (P less than 0.01), it increased with resuscitation but did not return to baseline even with infusion of fluid volumes of three times the blood loss. Flow decreased during hemorrhage in all organs, but the difference was not statistically significant in the liver (P greater than 0.05), since a larger percentage of CO was maintained as hepatic perfusion. During resuscitation, flow to brain and kidneys increased over the percentage values expected by increased CO (P less than 0.01), but flow to the liver did not increase significantly. Flow to small bowel remained depressed (P less than 0.005).

CONCLUSIONS

Following hemorrhage there is hypoperfusion of all splanchnic organs; however, flow to the liver decreases least. Crystalloid resuscitation in our model failed to return CO to baseline. Blood supply to intestine remained depressed in disproportion to CO both after hemorrhage and resuscitation and hepatic blood flow remained decreased after resuscitation.

Randomized comparison of metabolic control achieved by intraperitoneal insulin infusion with implantable pumps versus intensive subcutaneous insulin therapy in type I diabetic patients

OBJECTIVE

To compare intraperitoneal implantable insulin infusion (IP) to subcutaneous (SC) intensive insulin therapy.

RESEARCH DESIGN AND METHODS

Twenty-one insulin-dependent (type I) diabetic patients aged 24-61 yr underwent a 3-mo treatment optimization using multiple SC daily injections or external pumps. Patients were then randomized (time 0 mo) to IP infusion using Infusaid-programmable pumps or continuation on SC intensive insulin for 6 mo.

RESULTS

No differences were noted between study and control group data. However, longitudinal within-group comparisons from baseline showed that glycosylated hemoglobin improved to near-normal in both groups: IP, 9.0 +/- 0.5 vs. 7.8 +/- 0.6% (P less than 0.05) and SC, 8.4 +/- 0.5 vs. 7.5 +/- 0.3% (P less than 0.5) at 0 and 4 mo, respectively (normal less than 6.9%). The percentage of blood glucose tests greater than 11 mM at 0 and 6 mo was 28 +/- 5 vs. 16 +/- 4% in the IP group (P less than 0.05) and 22 +/- 5 vs. 24 +/- 7% in the SC group (NS). At 0 and 6 mo, the standard deviation of blood glucose values, an index of glycemic fluctuations, was 4.3 +/- 0.4 vs. 3.2 +/- 0.5 mM in the IP group (P less than 0.05) and 3.7 +/- 0.3 vs. 4.0 +/- 0.4 mM in the SC group (NS). Weight, insulin dosages, circulating lipid levels, and the frequency of severe hypoglycemic reactions and biochemical hypoglycemias were similar and did not change in the two groups.

CONCLUSIONS

IP-implantable pumps compared with SC intensive insulin therapy have similar effects on most metabolic variables and are equally effective at achieving near-normal glycemic levels. Only longitudinal data suggest that IP treatment may be more effective at limiting glycemic fluctuations.

Superoxide dismutase polyethylene glycol improves survival in hemorrhagic shock

Oxygen free radicals are known to form after reperfusion of ischemic tissue. To test the role and importance of oxygen free radicals in hemorrhagic shock, an animal model of hemorrhagic shock and resuscitation was utilized. Sprague-Dawley rats were anesthetized with halothane and then subjected to approximately 50 per cent blood volume hemorrhage (30 cc/kg), followed by a 60 min shock period. Resuscitation was performed over 1 hour with lactated ringers (LR) at a volume of two times blood loss (60 cc/kg). This model results in a survival rate of 25 per cent over 72 hrs. Using this model, animals were randomized to receive either LR, Superoxide Dismutase-Polyethylene Glycol (SOD-PEG) (15,000 units/kg) with LR or Catalase-Polyethylene Glycol (CAT-PEG) (175,000 units/kg) with LR. The group treated with SOD-PEG demonstrated significantly increased survival rates vs the group treated with LR (67% vs 25%, P = 0.02). The group treated with CAT-PEG demonstrated no significant improvement in survival when compared to the LR-treated group (20% vs 24%). These data suggest that treatment directed toward oxygen free radicals and reperfusion injury may play an important role in hemorrhagic shock resuscitation.

Advances in the management of hemorrhagic shock

The Scientific Board of the California Medical Association presents the following inventory of items of progress in general surgery. Each item, in the judgment of a panel of knowledgeable physicians, has recently become reasonably firmly established, both as to scientific fact and important clinical significance. The items are presented in simple epitome, and an authoritative reference, both to the item itself and to the subject as a whole, is generally given for those who may be unfamiliar with a particular item. The purpose is to assist busy practitioners, students, researchers, or scholars to stay abreast of these items of progress in general surgery that have recently achieved a substantial degree of authoritative acceptance, whether in their own field of special interest or another. The items of progress listed below were selected by the Advisory Panel to the Section on General Surgery of the California Medical Association, and the summaries were prepared under its direction.

Helmet use improves outcomes after motorcycle accidents

To determine the effects of motorcycle helmet use on the outcome of patients admitted to a Level I trauma center, we studied patient outcomes and demographic and epidemiologic variables of 474 patients injured in motorcycle collisions and treated at such a center over a 45-month period. Of those involved in a motorcycle collision, 50% were not wearing a helmet, 23% were wearing a helmet, and in 27% helmet use was unknown. Those who were wearing a helmet had fewer and less severe head and facial injuries, required fewer days on a ventilator, and sustained no serious neck injuries; fewer patients who wore helmets were discharged with disability, and hospital charges were lower. These data support the need for both increased public education regarding helmet use and mandatory helmet use legislation.

Is early prediction of outcome in severe head injury possible?

To determine whether the outcome of patients with severe head injury could be predicted early after presentation to the hospital, the records of 306 trauma patients with head injury and Glasgow Coma Scale scores of 10 or less were reviewed. There was poor correlation between initial scores at patient arrival and eventual outcome, while scores 6 hours after presentation correlated better with eventual outcome. Many patients with scores as low as 3 had good neurologic recovery. Patient age, associated injuries, blood pressure, mechanism of injury, presence of spontaneous ventilation, and computed tomographic findings all affected survival. However, considering even these parameters, statistical analysis could not provide sensitive prediction of outcome, which we defined as identifying those patients who eventually had good recovery. We conclude that initial therapy should be aggressive for patients with severe head injury, regardless of initial neurologic status, because accurate prediction of outcome within 6 hours of presentation is impossible.

Pentoxifylline in resuscitation of experimental hemorrhagic shock

BACKGROUND

Pentoxifylline improves survival in animal models of hemorrhagic shock. The purpose of this study was to determine the physiologic effects of pentoxifylline in hemorrhagic shock that may be responsible for improved survival.

METHODS

Randomized, prospective, blinded trials in Sprague-Dawley rats subjected to hemorrhage and resuscitation, with or without pentoxifylline.

RESULTS

Pentoxifylline had no effect on BP or cardiac output. However, tissue oxygenation and oxygen consumption were increased with pentoxifylline resuscitation. Pentoxifylline resuscitation also significantly decreased polymorphonuclear leukocyte adhesiveness.

CONCLUSIONS

Pentoxifylline improves tissue oxygenation and oxygen consumption posthemorrhage and this effect is not due to increased cardiac output. Therefore, it must be due to improved microcirculatory blood flow. This effect may be due to decreased polymorphonuclear leukocyte adhesiveness induced by pentoxifylline resuscitation.

Survival after hypertonic saline resuscitation from hemorrhage

There has been recent increased interest in hypertonic saline resuscitation from shock and hemorrhage. This study was performed to evaluate the survival effects of hypertonic saline resuscitation. Fifty male Sprague-Dawley rats of average weight of 325 grams were anesthetized with halothane. Animals were subjected to blood loss of 21 ml/kg over 5 minutes. Intravenous infusion was started 10 minutes after hemorrhage with either lactated Ringer's injection (42 ml/kg) or three per cent NaCl (10.64 ml/kg) chosen randomly. These doses provided equal amounts of sodium. At the end of fluid infusion, blood samples were obtained for electrolyte determination. Rats were observed 3 days for survival. Survival was significantly lower in the three per cent NaCl group compared with the lactated Ringer's group. It is probable that worsened outcome with three per cent NaCl was associated with intracellular dehydration.