Pyruvate-Fortified Fluid Resuscitation Improves Hemodynamic Stability While Suppressing Systemic Inflammation and Myocardial Oxidative Stress After Hemorrhagic Shock

Objectives: To determine whether controlled resuscitation with pyruvate-fortified Ringer's (PR) solution vs, conventional lactate Ringer's (LR) more effectively stabilizes mean arterial pressure (MAP) and suppresses myocardial inflammation postresuscitation. Methods: Goats were hemorrhaged (255 +/- 22 ml) to lower MAP to 48 +/- 1 mmHg. Next, the right femoral vessels were occluded for 90 min to model tourniquet application. Beginning at 30 min occlusion, LR or PR was infused iv at 10 ml/min for 90 min. The femoral occlusions were released at 60 min infusion. Results: At 4 h postocclusion, MAP (mmHg) was increased in PR (59 +/- 4) vs. LR (47 +/- 3) resuscitated goats (p < 0.05). PR also more effectively augmented circulating HCO3- and total base excess. Nitrosative stress, detected in myocardium 4 h after LR resuscitation, was suppressed by PR. Finally, PR prevented the increase in circulating neutrophils that accompanied LR resuscitation. Conclusions: Relative to L.R. resuscitation with PR more effectively stabilized MAP, suppressed myocardial nitrosative stress and minimized systemic inflammation after hemorrhagic shock with hindlimb ischemia-reperfusion.