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Restoration of Body Temperature to Normothermia During Resuscitation Following Trauma-Hemorrhage Improves the Depressed Cardiovascular and Hepatocellular Functions
Yasuaki Mizushima, MD;
Ping Wang, MD;
William G. Cioffi, MD;
Kirby I. Bland, MD;
Irshad H. Chaudry, PhD
Arch Surg. 2000;135:175-181.
Hypothesis Rewarming the body to 37°C during resuscitation following trauma-hemorrhage has salutary effects on cardiovascular and hepatocellular functions.
Design, Interventions, and Main Outcome Measures Male rats underwent laparotomy (trauma induced) and were then bled to and maintained at a mean arterial pressure of 40 mm Hg until 40% of the maximum shed blood volume was returned in the form of Ringer lactate solution. Rats were exposed to ambient temperature and allowed to become hypothermic during hemorrhage. The animals were then resuscitated with 4 times the volume of shed blood with Ringer lactate solution for 60 minutes. In 1 group, the body temperature was rewarmed to 37°C during resuscitation. In another group, the body temperature was maintained at hypothermia (32°C) for 4 hours after resuscitation. In an additional group, the body temperature was kept at 37°C during hemorrhage and resuscitation. At 4 hours after resuscitation, the rats were returned to a room with ambient temperature. Various in vivo heart performance variables (maximal rate of pressure increase and decrease), cardiac output, hepatocellular function, and plasma IL-6 level were determined at 24 hours after resuscitation.
Results Either maintenance of normothermia during hemorrhage or prolonged hypothermia following resuscitation had deleterious effects on cardiovascular variables and hepatocellular function and up-regulated plasma IL-6 levels. In contrast, rewarming the body to 37°C during resuscitation improved cardiac contractility, cardiac output, and hepatocellular function and reduced plasma IL-6 level.
Conclusion Since rewarming the body temperature to normothermia during resuscitation improved depressed cardiovascular and hepatocellular functions, this should be considered as a useful adjunct to fluid resuscitation after trauma-hemorrhage.
From the Center for Surgical Research and the Department of Surgery, Brown University School of Medicine and Rhode Island Hospital, Providence. Dr Bland is now with the Department of Surgery, University of Alabama, Birmingham.
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