Depressed Gut Absorptive Capacity Early After Trauma-Hemorrhagic Shock

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Abstract
Although bacterial translocation occurs after trauma-hemorrhage, it is unknown whether gut absorptive capacity (GAC) is altered under those conditions. The aim of this study, therefore, was to determine this and also whether diltiazem (DZ) has any effect on GAC after hemorrhage. Rats (n = 12; 270 to 300 g) were lightly anesthetized with ether and a 6-cm midline laparotomy performed (i.e., trauma induced). A nasogastric tube was inserted, cannulation of a carotid and femoral artery and a jugular and the portal veins performed, and the animals allowed to recover from anesthesia. They were then bled to a mean blood pressure of 40 mm Hg within 10 minutes and maintained at this pressure by further bleeding or return of fluid (lactated Ringer's solution [LRS] ) until 40% of the shed blood volume (SBV) had been returned in the form of LRS (end of hemorrhage, EH; time from onset of hemorrhage to EH = 93.4 +/- 4.4 minutes). The rats then were resuscitated with LRS, 3 times the SBV over 45 minutes, followed by 2x over 60 minutes. One group received 400 micrograms/kg DZ, and another group received saline, with the 2x LRS. Sham animals were not hemorrhaged. Gut absorptive capacity was determined by the 1-hour D-xylose absorption test at 2 and 4 hours after EH. Results demonstrate that GAC is significantly depressed after hemorrhage and resuscitation. Administration of diltiazem restored GAC to normal levels. Thus DZ is a useful adjuvant to treatment after trauma-hemorrhagic shock, because it restores GAC to normal and allows for early enteral nutrition.