Journal
JOURNAL OF NEUROTRAUMA
Volume 26, Issue 12, Pages 2403-2408Publisher
MARY ANN LIEBERT, INC
DOI: 10.1089/neu.2009.0980
Keywords
colloid; head injury; nitroxide; oxidative stress; secondary insult
Funding
- U.S. Army [PR054755 81-06-10247]
- NIH [NS 38087, NS 30318]
- National Institute of Child Health and Human Development [T32]
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Outcome after traumatic brain injury (TBI) is worsened by hemorrhagic shock (HS), but the optimal resuscitation approach is unclear. In particular, treatment of TBI patients with colloids remains controversial. We hypothesized that resuscitation with the colloids polynitroxylated albumin (PNA) or Hextend (HEX) is equal or superior to resuscitation with the crystalloids hypertonic (3%) saline (HTS) or lactated Ringer's solution (LR) after TBI plus HS in mice. C57/BL6 mice (n=30) underwent controlled cortical impact (CCI) and 90 min of volume-controlled HS (2mL/100g). The mice were randomized to resuscitation with LR, HEX, HTS, or PNA, followed by 30 min of test fluid administration targeting a mean arterial pressure (MAP) of >50mm Hg. Shed blood was re-infused to target a MAP>70mm Hg. At 7 days post-insult, hippocampal neuron counts were assessed in hematoxylin and eosin-stained sections to quantify neuronal damage. Prehospital MAP was higher, and pre-hospital and total fluid requirements were lower in the PNA and HEX groups (p<0.05 versus HTS or LR). Also, 7-day survival was highest in the PNA group, but was not significantly different than the other groups. Ipsilateral hippocampal CA1 and CA3 neuron loss did not differ between groups. We conclude that the colloids PNA and HEX exhibited more favorable effects on acute resuscitation parameters than HTS or LR, and did not increase hippocampal neuronal death in this model.
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