The Effect of Hypertonic Resuscitation for Blunt Trauma

高渗复苏治疗钝挫伤的效果

• 批准号: 6595669
• 负责人: EILEEN M BULGER
• 金额: $ 45.33万
• 依托单位: UNIVERSITY OF WASHINGTON
• 依托单位国家: 美国
• 财政年份: 2003
• 资助国家: 美国
• 起止时间: 2003-04-01 至 2007-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6595669
• 关键词: adult respiratory distress syndrome; brain injury; cellular immunity; clinical research; clinical trials; dextrans; helper T lymphocyte; human subject; human therapy evaluation; hypovolemia; interleukin 10; interleukin 2; interleukin 4; leukocyte activation /transformation; monocyte; multiple organ failure; neuroprotectants; neutrophil; outcomes research; patient oriented research; resuscitation; saline; shock; trauma

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.

描述（由申请人提供）： 创伤性损伤后的传统复苏低血容量休克涉及大量乳酸铃声（LR）溶液的迅速给药。先前的研究表明，使用高渗溶液的初始复苏将导致血压更快恢复，改善脑灌注以及对缺血/再灌注损伤的全身性炎症反应的调节。该提案旨在评估钝性创伤性损伤后休克患者的临床结果和炎症细胞功能，这些损伤被随机分配，以接受7.5％的高渗盐水/6％葡萄糖（HSD），其次是LR与LR相对于LR。我们假设HSD复苏将抑制炎症反应的最初过度系统性激活，这将转化为该反应引起的器官功能障碍的发生率的降低。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，该亚组在这种干预措施中具有最大的生存优势。该提案的具体目的包括：目标1：确定院前施用高渗盐水/葡萄糖对钝性外伤性损伤后发育的高渗盐水/葡萄糖对发育的影响。 目的2：确定院前盐水/葡萄糖对脑损伤后神经系统结局的影响。“对于降血性休克患者的患者”。目的3A：确定hypertonic盐水/葡萄糖疗养前施用hypertonic盐水/葡萄糖对循环中性粒细胞和单粒细胞的循环效应的影响。要确定效应的效应，以确定效应的效应。 T淋巴细胞的激活是基于先前的研究，证明了这种复苏策略在院前环境中的安全性和实用性。