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Heparan preserves intestinal perfusion after hemorrhage and resuscitation
J M Watkins1, D A Spain, R J Krysztopik
1Department of Surgery, University of Louisville School of Medicine, Kentucky 40292, USA.
Background:
Multiple system organ failure (MOF) remains a major source of morbidity and mortality in trauma patients. Despite restoration of central hemodynamics, intestinal hypoperfusion can persist. Mucosal ischemia and barrier breakdown are factors in the genesis of MOF. Heparan sulfate is a gycosaminoglycan similar to heparin, but with minimal anticoagulant properties. As an adjunct to resuscitation, it improves immunologic function and restores mucosal oxygenation and function. We hypothesized that resuscitation with heparan following hemorrhage wound prevents intestinal hypoperfusion.
Materials And Methods:
In vivo videomicroscopy was used to study small intestine microcirculation in rats. Animals were hemorrhaged to 50% of baseline mean arterial pressure (MAP) and maintained there. Resuscitation was initiated when the return of 10% shed blood was required to keep MAP at 50%. Animals received either heparan (7 mg/kg/1 ml saline) or saline (1 ml) followed by the remaining shed blood and an equal volume of saline. MAP, cardiac output (CO), A1 arteriole diameters, and flow were determined.
Results:
Resuscitation of the saline control group resulted in normal MAP with elevation of CO to 25-40% above baseline. The heparan group had return of MAP but only a moderate increase in CO (7-15%). Saline resuscitation led to progressive deterioration in A1 diameters and flow. The addition of heparan prevented delayed A1 constriction and significantly improved perfusion.
Conclusions:
Heparan prior to resuscitation improved intestinal perfusion, despite a relative reduction in CO. Improvement in nutrient blood flow may protect the mucosal barrier, reducing the incidence of MOF, and suggests that heparan may be useful in resuscitation of trauma patients.
Insights
Resuscitating trauma patients with heparan sulfate improved intestinal perfusion by preventing hypoperfusion, potentially reducing multiple system organ failure (MOF). This suggests heparan sulfate is a valuable adjunct in trauma resuscitation.
Area of Science:
- Trauma resuscitation
- Gastrointestinal physiology
- Organ failure research
Background:
- Multiple system organ failure (MOF) is a significant cause of death in trauma patients.
- Intestinal hypoperfusion can persist despite hemodynamic stabilization, contributing to MOF.
- Heparan sulfate, a heparin-like glycosaminoglycan, may improve immunologic function and restore mucosal oxygenation.
Purpose of the Study:
- To investigate the hypothesis that resuscitation with heparan sulfate following hemorrhage prevents intestinal hypoperfusion in trauma.
- To evaluate the effects of heparan sulfate on intestinal microcirculation during resuscitation.
Main Methods:
- In vivo videomicroscopy was used to assess rat small intestine microcirculation.
- Animals were subjected to hemorrhage to 50% of baseline mean arterial pressure (MAP).
- Resuscitation involved administration of either heparan sulfate or saline before returning shed blood and infusing additional saline.
Main Results:
- Saline resuscitation normalized MAP but led to progressive deterioration of microvascular A1 arteriole diameters and flow.
- Heparan sulfate resuscitation maintained MAP with only a moderate increase in cardiac output (CO).
- Heparan sulfate prevented delayed A1 constriction and significantly improved intestinal perfusion compared to saline.
Conclusions:
- Heparan sulfate administration improved intestinal perfusion in hemorrhaged rats, despite a blunted CO response.
- Enhanced nutrient blood flow may protect the intestinal mucosal barrier, potentially reducing MOF incidence.
- Heparan sulfate shows promise as a beneficial agent in the resuscitation of trauma patients.