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Joachim F. Kuebler, MD; Doraid Jarrar, MD; Balazs Toth, MD; Kirby I. Bland, MD; Loring Rue III, MD; Ping Wang, MD; Irshad H. Chaudry, PhD

Arch Surg. 2002;137:74-79.

Hypothesis  The female sex steroid 17-estradiol improves immune functions following trauma-hemorrhage in rodent models. Therefore, we hypothesized that 17-estradiol administration following trauma-hemorrhage would also improve cardiac output, splanchnic perfusion, and oxygen utilization, even after the induction of subsequent sepsis.

Setting  A university laboratory.

Intervention  Male rats underwent midline laparotomy (ie, soft tissue injury). They were bled to a mean arterial pressure of 35 to 40 mm Hg for 90 minutes and resuscitated over 60 minutes with lactated Ringer solution. At the beginning of resuscitation, 17-estradiol (l mg/kg) or a vehicle was administered. At 20 hours after resuscitation, polymicrobial sepsis was induced by cecal ligation and puncture (CLP).

Main Outcome Measures  At 5 hours after CLP, cardiac performance (via a left ventricular catheter), cardiac output, and organ blood flow were determined using strontium 85 microspheres. Blood samples were collected from the femoral artery and jugular, portal, and renal veins to determine systemic and regional oxygen delivery and consumption. Moreover, circulating levels of 17-estradiol, its adrenal precursor dehydroepiandrosterone (DHEA), and corticosterone were assessed by enzyme-linked immunosorbent assay.

Results  Hemorrhage and subsequent sepsis significantly depressed cardiac performance, cardiac output, organ perfusion, and oxygen consumption. Estrogen did not restore cardiac output or systemic oxygen consumption; nonetheless, it restored the depressed intestinal perfusion. Rats treated with estrogen had significantly elevated levels of plasma 17-estradiol, but the levels of DHEA or corticosterone were not affected.

Conclusions  The increase in gut perfusion could represent a potential mechanism for the salutary effects of 17-estradiol following trauma-hemorrhage. Because 17-estradiol improves systemic and intestinal perfusion after trauma-hemorrhage and induction of subsequent sepsis, this agent appears to be a promising adjunct for the treatment of trauma victims.

From the Center for Surgical Research and the Department of Surgery, University of Alabama at Birmingham.

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