Variable saline resuscitation in a murine model of combined traumatic brain injury and haemorrhage

ABSTRACT

Background: Resuscitation strategies for combined traumatic brain injury (TBI) with haemorrhage in austere environments are not fully established. Our aim was to establish the effects of various saline concentrations in a murine model of combined TBI and haemorrhage, and identify an effective resuscitative strategy for the far-forward environment.

Methods: Male C57BL/6 mice underwent closed head injury and subjected to controlled haemorrhage to a systolic blood pressure of 25 mmHg via femoral artery cannulation for 60 min. Mice were resuscitated with a fixed volume bolus or variable volumes of fluid to achieve a systolic blood pressure goal of 80 mmHg with 0.9% saline, 3% saline, 0.1-mL bolus of 23.4% saline, or a 0.1-mL bolus of 23.4% saline followed by 0.9% saline (23.4+).

Results: 23.4% saline and 23.4+ resulted in higher mortality at 6 h compared to 0.9% saline. Use of 3% saline required less volume to achieve targeted resuscitation, did not affect survival, and did not exacerbate post-traumatic inflammation. While 23.4+ resuscitation utilized lower volume, it resulted in hypernatremia, azotemia, and elevated systemic pro-inflammatory cytokines. All groups except 3% saline demonstrated progression of neuron damage, with cerebral oedema highest with 0.9% saline.

Conclusions: 3% saline demonstrated favourable balance of survival, blood pressure restoration, minimization of inflammation, and prevention of ongoing neurologic injury without contributing to significant physiologic derangements. 23.4% saline administration may not be appropriate in the setting of concomitant hypotension.

KEYWORDS:

• Traumatic brain injury
• haemorrhagic shock
• polytrauma
• saline resuscitation
• hypertonic saline

Declaration of Interest

The authors report no proprietary or commercial interest in any product mentioned or concept discussed in this article. This project was made possible through support by the United States Air Force and funded by the United States Air Force School of Aerospace Medicine, contract number FA8650-14-2-6B29. This manuscript was cleared for publication by OPSEC/STINFO, case number 88ABW-2017-3640. The experimental protocol was cleared through UC and SGE-C IACUC. The views expressed in this article are those of the authors and do not necessarily reflect the official policy or position of the Air Force, the Department of Defense, or the U.S. Government.

Additional information

Notes on contributors

Michael Goodman

Jung: analysis of data, drafting of manuscript, critical revisions of manuscript, and approval of final version; Johnson: acquisition of data and approval of final version; Veile: acquisition of data and approval of final version; Friend: acquisition of data and approval of final version; Stevens-Topie: acquisition of data and approval of final version; Elterman: study design, critical revisions of manuscript, and approval of final version; Pritts: study design, critical revisions of manuscript, and approval of final version; Makley: study design, critical revisions of manuscript, and approval of final version; Goodman: study design, analysis of data, drafting of manuscript, critical revisions of manuscript, and approval of final version.