BACKGROUND: : Resuscitation with hypertonic saline or hypertonic saline plus l-arginine acutely improves cerebral blood flow after traumatic brain injury (TBI) followed by hemorrhagic hypotension. The authors investigated whether hypertonic saline or hypertonic l-arginine would improve long-term neuronal survival and behavioral outcomes 15 days after TBI and hemorrhagic hypotension. METHODS: : Mean arterial pressure, arterial blood gases, pH, plasma glucose, hematocrit, and hemoglobin were measured in male Sprague-Dawley rats before and after moderate (2.0 atm) fluid percussion TBI. Rats were assigned to one of six groups: (1) sham TBI, (2) hemorrhage only, (3) TBI only, (4) TBI plus hemorrhage and resuscitation with 0.9% saline, (5) TBI plus hemorrhage and resuscitation with hypertonic saline (7.5%), or (6) TBI plus hemorrhage and resuscitation with l-arginine (100 mg/kg) in hypertonic saline. On postinjury days 1-5, vestibulomotor function was assessed using beam balance and beam walking tasks. On postinjury days 11-15, spatial memory function was assessed using the Morris water maze. After behavioral testing, neuronal counting was performed bilaterally on specific hippocampal regions. RESULTS: : Groups receiving hypertonic saline (P < 0.05, day 15 vs. day 11) or hypertonic l-arginine (P < 0.05, days 13-15 vs. day 11) showed improved performance over time on the Morris water maze, as well as significantly improved neuronal survival in the contralateral hippocampus (P < 0.05, hypertonic saline or hypertonic l-arginine vs. normal saline) compared with untreated TBI or normal saline-treated TBI plus hemorrhage groups. CONCLUSIONS: : Hypertonic saline and hypertonic l-arginine were both effective at promoting long-term neuronal survival and behavioral recovery. The slightly earlier improvement in Morris water maze performance in the hypertonic l-arginine group warrants further studies to determine whether higher doses of l-arginine provide additional improvement. This study supports the therapeutic benefits of hypertonic resuscitation after TBI plus hemorrhagic hypotension.
BACKGROUND: : Resuscitation with hypertonic saline or hypertonicsaline plus l-arginine acutely improves cerebral blood flow after traumatic brain injury (TBI) followed by hemorrhagic hypotension. The authors investigated whether hypertonic saline or hypertonicl-arginine would improve long-term neuronal survival and behavioral outcomes 15 days after TBI and hemorrhagic hypotension. METHODS: : Mean arterial pressure, arterial blood gases, pH, plasma glucose, hematocrit, and hemoglobin were measured in male Sprague-Dawley rats before and after moderate (2.0 atm) fluid percussion TBI. Rats were assigned to one of six groups: (1) sham TBI, (2) hemorrhage only, (3) TBI only, (4) TBI plus hemorrhage and resuscitation with 0.9% saline, (5) TBI plus hemorrhage and resuscitation with hypertonic saline (7.5%), or (6) TBI plus hemorrhage and resuscitation with l-arginine (100 mg/kg) in hypertonic saline. On postinjury days 1-5, vestibulomotor function was assessed using beam balance and beam walking tasks. On postinjury days 11-15, spatial memory function was assessed using the Morris water maze. After behavioral testing, neuronal counting was performed bilaterally on specific hippocampal regions. RESULTS: : Groups receiving hypertonic saline (P < 0.05, day 15 vs. day 11) or hypertonicl-arginine (P < 0.05, days 13-15 vs. day 11) showed improved performance over time on the Morris water maze, as well as significantly improved neuronal survival in the contralateral hippocampus (P < 0.05, hypertonic saline or hypertonicl-arginine vs. normal saline) compared with untreated TBI or normal saline-treated TBI plus hemorrhage groups. CONCLUSIONS: : Hypertonic saline and hypertonicl-arginine were both effective at promoting long-term neuronal survival and behavioral recovery. The slightly earlier improvement in Morris water maze performance in the hypertonicl-arginine group warrants further studies to determine whether higher doses of l-arginine provide additional improvement. This study supports the therapeutic benefits of hypertonic resuscitation after TBI plus hemorrhagic hypotension.
Authors: Eileen M Bulger; Susanne May; Karen J Brasel; Martin Schreiber; Jeffrey D Kerby; Samuel A Tisherman; Craig Newgard; Arthur Slutsky; Raul Coimbra; Scott Emerson; Joseph P Minei; Berit Bardarson; Peter Kudenchuk; Andrew Baker; Jim Christenson; Ahamed Idris; Daniel Davis; Timothy C Fabian; Tom P Aufderheide; Clifton Callaway; Carolyn Williams; Jane Banek; Christian Vaillancourt; Rardi van Heest; George Sopko; J Steven Hata; David B Hoyt Journal: JAMA Date: 2010-10-06 Impact factor: 56.272
Authors: Joseph N Hemerka; Xianren Wu; C Edward Dixon; Robert H Garman; Jennifer L Exo; David K Shellington; Brian Blasiole; Vincent A Vagni; Keri Janesko-Feldman; Mu Xu; Stephen R Wisniewski; Hülya Bayır; Larry W Jenkins; Robert S B Clark; Samuel A Tisherman; Patrick M Kochanek Journal: J Neurotrauma Date: 2012-08-10 Impact factor: 5.269
Authors: Lesley M Foley; Alia M Iqbal O'Meara; Stephen R Wisniewski; T Kevin Hitchens; John A Melick; Chien Ho; Larry W Jenkins; Patrick M Kochanek Journal: J Cereb Blood Flow Metab Date: 2012-10-17 Impact factor: 6.200
Authors: Wolfgang G Junger; Shawn G Rhind; Sandro B Rizoli; Joseph Cuschieri; Andrew J Baker; Pang N Shek; David B Hoyt; Eileen M Bulger Journal: Shock Date: 2013-11 Impact factor: 3.454
Authors: Shawn G Rhind; Naomi T Crnko; Andrew J Baker; Laurie J Morrison; Pang N Shek; Sandro Scarpelini; Sandro B Rizoli Journal: J Neuroinflammation Date: 2010-01-18 Impact factor: 8.322