The Effect of Hypothermia on Splanchnic Flows and Lung in a Two-Hit
Hemorrhagic Shock Model
1
Turgut Deniz, M.D.,
*
,2
Canan Agalar, M.D.,† Fatih Agalar, M.D.,‡ Faruk M. Comu, M.D.,§
Osman Caglayan, M.D.,{ Yesim Alpay, M.D.,† and Oral Saygun, M.D.‡
*Department of Emergency Medicine; †Department of Clinical Microbiology and Infection; ‡Department of General Surgery; §Department of
Physiology; and
{
Department of Biochemistry, Kirikkale University Medical School, Suleyman Demirel Research and Training Hospital,
Kirikkale, Turkey
Submitted for publication June 10, 2008
Background. To evaluate the effect of hypothermia
on bacterial translocation, splanchnic vascular flow,
lung tissue weight, and levels of malondialdehyde
(MDA) and nitric oxide (NO) in a two-hit model of hem-
orrhagic shock.
Methods. Thirty rats were randomly allocated into
three groups of 10 rats each. In the control group
(group C), rats were treated without hemorrhage,
and normothermia (37
C) was maintained. In the
mild hypothermia group (group MH), rats were sub-
jected to volume-controlled hemorrhage (2 mL/100g)
and a rectal temperature of 34
C was maintained. In
the normothermic group (group NT), rats were treated
as in group MH, except for hypothermia. Seventy-two
hours after hemorrhagic shock (first insult), Pseudo-
monas aeuruginosa was administered intratracheally
as a second insult. Finally, mesenteric vascular flow
patterns were recorded. Bacterial translocation was
studied from tissue samples of spleen, liver, and mesen-
teric lymph nodes. Blood samples were obtained to
evaluate the possible presence of bacteria in the blood-
stream. Lung tissue weight ratio, MDA, and NO levels
in lung tissue were assessed.
Results. Renal, mesenteric, and portal venous flow
rates were found to be lower in groups MH and NT in
comparison with group C. Blood flow profiles were
lower in group NT than in group MH (P < 0.05). Bacte-
rial translocation was not observed in group C, and it
was detected more often in group NT than in group
MH. Lung weight ratio was found to be higher in group
NT compared with groups MH and C. Although it did
not reach the level of statistical significance, MDA level
in the control group was lower than that in the NT
group (P [ 0.085).
Conclusion. Hypothermia corrected mesenteric
blood flow and decreased the occurrence of bacterial
translocation in the two-hit model of hemorrhagic
shock and tracheal inoculaton of P. aeruginosa
Ó 2010
Elsevier Inc. All rights reserved.
Key Words: hemorrhagic shock; hypothermia;
trauma; rat; two-hit model.
INTRODUCTION
Despite recent advances in treatment facilities in
trauma and hemorrhage, they remain important
causes of mortality and morbidity. The gut has a vital
role in response to hemorrhage, especially after hypo-
perfusion [1, 2], and intestinal mucosal barrier distrup-
tion may lead to infectious complications after trauma
and hemorrhage [3]. Increased permeability changes
are important alterations in mucosal barrier function.
Disruption of the epithelial lining as a consequence of
mucosal hypoxia and ischemia reperfusion injury leads
to passing of bacteria and bacteria-derived substances
from the gut lumen to the systemic circulation via dia-
phragmatic lymphatics and the portal vein [4]. Eventu-
ally, this leads to sepsis and multi organ failure (MOF).
Two-hit models of trauma have been proposed to ex-
plain acute respiratory distress syndrome (ARDS) after
trauma seen under clinical conditions. The philosophy
of these models is to prime the neutrophils to alveolar
cells, with a second nonlethal insult such as endotoxin
1
This work was partly presented in EKMUD Congress that was
held in Ankara, Turkey, April 29–May 3, 2008.
2
To whom correspondence and reprint requests should be ad-
dressed at Kirikkale Universitesi, Tip Fakultesi, Acil Tip A.D., Fabri-
kalar Mah. Saglik Cad. 71100, Kirikkale, Turkey. E-mail:
turgutdeniz@yahoo.com.
0022-4804/10 $36.00
Ó 2010 Elsevier Inc. All rights reserved.
121
Journal of Surgical Research 158, 121–126 (2010)
doi:10.1016/j.jss.2008.08.029