The Effect of Hypertonic Resuscitation for Blunt Trauma

描述(由申请人提供)： 创伤后低血容量性休克的常规复苏需要快速给予大量乳酸林格液(LR)。先前的研究表明，使用高渗液进行初始复苏可以更快地恢复血压，改善脑血流，并调节全身对缺血/再灌注损伤的炎症反应。这项建议旨在评估钝性创伤后休克患者的临床结果和炎症细胞功能，这些患者随机接受7.5%高渗盐水/6%葡聚糖(HSD)治疗，然后接受LR和单独接受LR。我们假设HSD复苏将抑制最初过度的全身性炎症反应的激活，这将转化为减少由这种反应引起的器官功能障碍的发生率。此外，我们试图评估HSD复苏对创伤性脑损伤后恢复的影响，因为先前的研究表明，这一亚组从这种干预中获得了最大的生存优势。该建议的具体目的包括：目的1：确定院前给予高渗盐水/右旋糖酐对闭合性创伤合并低血容量性休克后器官衰竭的影响。目的：探讨低血容量性休克患者院前给予高渗盐水/右旋糖酐对脑损伤后神经预后的影响。目的：探讨院前应用高渗盐水/右旋糖酐对循环中性粒细胞和单核细胞活化的影响。目的3b：探讨院前给予高渗盐水/右旋糖酐对T淋巴细胞活化的影响。这项建议建立在先前的研究基础上，这些研究已经证明了这种复苏策略在院前环境中的安全性和实用性。更详细地了解高张血症对所有患者的免疫炎症效应以及对脑损伤患者的长期神经学结果，对于确定这种复苏方法在这些危重患者中的作用至关重要。

DESCRIPTION (provided by applicant): Conventional resuscitation of hypovolemic shock following traumatic injury involves the rapid administration of large volumes of lactated ringers (LR) solution. Previous research suggests that initial resuscitation with a hypertonic solution will result in more rapid restoration of blood pressure, improved cerebral perfusion, and modulation of the systemic inflammatory response to ischemia/reperfusion injury. This proposal seeks to evaluate the clinical outcome and inflammatory cell function of patients in shock following blunt traumatic injury who are randomized to receive 7.5% hypertonic saline/6% dextran (HSD) followed by LR versus LR alone. We hypothesize that HSD resuscitation will inhibit the initial excessive systemic activation of the inflammatory response, which will translate into a reduction in the incidence of organ dysfunction induced by this response. Furthermore, we seek to evaluate the impact of HSD resuscitation on recovery following traumatic brain injury, as previous studies suggest that this subgroup has the greatest survival advantage from this intervention. The specific aims for this proposal include: Aim 1: To determine the impact of pre-hospital administration of hypertonic saline/dextran on the development of organ failure following blunt traumatic injury with hypovolemic shock. Aim 2: To determine the impact of prehospital administration of hypertonic saline/dextran on the neurologic outcome following brain injury" for patients in hypovolemic shock. Aim 3a: To determine the effect of prehospital administration of hypertonic saline/dextran on the activation of circulating neutrophils and monocytes. Aim 3b: To determine the effect of prehospital administration of hypertonic saline/dextran on the activation of T lymphocytes. This proposal builds upon previous research which has demonstrated the safety and practicality of this resuscitation strategy in the prehospital environment. A more detailed understanding of the immuno-inflammatory effects of hypertonicity for all patients and the long-term neurologic outcome for patients with brain injury is critical to determining the role of this resuscitation approach in these critically injured patients.