Role of fluid replacement, increased oxygen availability by perfluorochemicals and enhanced RES function in the treatment of mesenteric occlusion shock

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Abstract
Experiments were carried out on 183 rats to study the effect of a complex therapy for treatment of mesenteric shock. The superior mesenteric artery (SMA) was temporarily ligated for 90 min under ether anesthesia; this was followed by an analgesic treatment. After release of the ligated artery, fluid therapy was instituted by administering the equivalent of 7.5% of body weight of one of three different solutions: ringer lactate (RL), hydroxyethyl starch (HES) in RL, and perfluorochemicals (PFC, 4g/kg b.wt. in RL with HES), the latter with the aim to improve the oxygen transport to the tissue. The same fluid therapy was carried out on rats pretreated withE. coli endotoxin. Endotoxin pretreatment was chosen to compensate the negative effect of PFC on the reticuloendothelial system (RES) as shown in previous studies [15]. Survival time and survival rate were recorded as well as hematocrit values at different times before and after treatment. Experimental groups were:Controls: (1) SMA occlusion without release; (2) 90-min occlusion without therapy.Treated animals: (3) RL therapy; (4) therapy with HES in RL; (5) therapy with PFC in RL and HES; (6), (7), and (8) identical therapies as Groups 3, 4, and 5, respectively, but with endotoxin pretreatment. Survival time increased to the same extent if HES or PFC were added to RL. There was a further increase both in survival times and rates with endotoxin pretreatment (Groups 6, 7, and 8 vs. Groups 3, 4, and 5). The highest survival time and rate were obtained in Group 8, which received PFC therapy with endotoxin pretreatment. There was a slight negative correlation between survival time and hematocrit values if all groups were considered together. It was found that the most effective antishock treatment combines fluid therapy with a higher O2 content in the blood, achieved by the PFC emulsion, but that this combination was effective only under a pretreatment stimulating the RES. A further goal is to look for other mechanisms circumventing the need for the pretreatment part of therapy.