Direct peritoneal resuscitation improves inflammation, liver blood flow, and pulmonary edema in a rat model of acute brain death.

Abstract

BACKGROUND:

Brain death in organ donors alters central hemodynamic performance, impairs physiology, exaggerates inflammation, and causes end-organ microcirculatory dysfunction and hypoxia. A new treatment, direct peritoneal resuscitation (DPR), might improve these derangements in acute brain death (ABD).

STUDY DESIGN:

We studied a standardized rodent model of brain death with matched controls to assess the efficacy of DPR as a resuscitation strategy after ABD. Anesthetized Sprague-Dawley rats were randomized as follows: ABD (supradural balloon inflation) with minimal IV fluid (IVF; 2 mL/h, n = 12); ABD + adequate IVF (5 mL/h, n = 12); ABD with aggressive IVF (goal: mean arterial pressure [MAP] >80 mmHg, n = 15); or ABD + IVF + DPR (goal: MAP >80 mmHg, n = 12). Ventilation support, IVF, and DPR were started at loss of reflexes, and MAP, heart rate, and effective hepatic blood flow were recorded.

RESULTS:

High IVF and DPR prevented mortality (0%) compared with low IVF (81.8%) or mid IVF (16.7%). Effective hepatic blood flow was decreased in low and mid IVF (2.8 ± 0.3 mL/min/g body weight and 4.0 ± 0.5 mL/min/g body weight, respectively) vs baseline, but was stable in high IVF (6.2 ± 0.5 mL/min/g body weight; NS) or improved with DPR (8.6 ± 0.7 mL/min/g body weight). The high-IVF group had significant organ edema, which was prevented in the DPR group. The mid-IVF and low-IVF groups had higher serum markers of organ injury compared with high-IVF or DPR groups. The high-IVF group had elevated inflammatory cytokines compared with the DPR group.

CONCLUSIONS:

Direct peritoneal resuscitation improved survival and effective hepatic blood flow, required less IVF to stabilize blood pressure, prevented organ edema, and normalized fluid electrolyte balance compared with IVF-alone groups. Direct peritoneal resuscitation in animals reduced inflammatory response after ABD compared with IVF-alone controls. These data suggest a potential role for DPR in organ donors to stabilize donors and possibly increase the number of organs suitable for transplantation per donor.

• Authors: Jason W Smith, Cameron A Ghazi, Brandon C Cain, Ryan T Hurt, R Neal Garrison, Paul J Matheson
• Journal: Journal of the American College of Surgeons (J Am Coll Surg) Vol. 219 Issue 1 Pg. 79-87 (Jul 2014) ISSN: 1879-1190 [Electronic] United States
• PMID: 24952444 (Publication Type: Evaluation Study, Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2014 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

Chemical References

• Electrolytes

Topics

• Animals
• Brain Death (physiopathology)
• Electrolytes (therapeutic use)
• Fluid Therapy (methods)
• Inflammation (etiology, prevention & control)
• Injections, Intraperitoneal
• Liver Circulation
• Pulmonary Edema (etiology, prevention & control)
• Random Allocation
• Rats
• Rats, Sprague-Dawley
• Resuscitation (methods)
• Tissue and Organ Procurement