Impact of oral resuscitation on circulating and splenic leukocytes after burns

Belinda I. Gómez, Brenna K. Harrington, Tony Chao, Kevin K. Chung, Michael A. Dubick, Nathan A. Boggs, David M. Burmeister

Research output: Contribution to journalArticle

Abstract

Background: Hemodynamic aberrations after severe burns are treated with aggressive intravenous (IV) fluid resuscitation however, oral resuscitation has been proposed in resource poor scenarios. Previously we have shown that animals receiving oral fluid following burns were able to recover kidney function. However, immune function such as circulating and splenic immune cell populations after oral or intravenous fluid administration was not examined. Herein, we perform a follow up analysis of splenic tissue and plasma from the previous animal study to examine the splenic response following these resuscitation strategies after burn injury. Methods: Eighteen anesthetized Yorkshire swine receiving 40%TBSA contact burns were randomized to receive either: (1) no fluids (Fluid Restricted; negative control), (2) 70 mL/kg/d Oral Rehydration Salt solution (Oral), or (3) 2 mL/kg/%TBSA/d of lactated Ringer's solution IV. Blood was drawn for blood cell analysis, and CT scans were performed before and 48 h post-burn, at which point spleens were harvested for histological, Western blot, and RT-PCR analyses. Results: Splenic artery diameter decreased by −0.97 ± 0.14 mm in fluid-restricted animals, while IV led to an increase of 0.68 ± 0.30 mm. No significant differences were detected in white and red pulp. IV fluids reduced the population of splenic monocytes (CD163; P = 0.001) and neutrophils (MPO protein; P = 0.13), as well as cytokines IL-8 (P = 0.003), IFN-γ (P = 0.11) and TNFα (P = 0.05). Additionally, withholding IV fluids consistently decreased the expression of FoxP3, CCR6, and IL17β in spleen, suggesting a shift in T-cell phenotype with IV resuscitation. Conclusions: The route of fluid administration has a minor influence on the changes in circulating and splenic leukocytes post-burn in the acute phase. Further research is needed to help guide resuscitation approaches using immunologic markers of splenic function following burns.

Original languageEnglish (US)
JournalBurns
DOIs
StateAccepted/In press - Jan 1 2019
Externally publishedYes

Fingerprint

Burns
Resuscitation
Leukocytes
Spleen
Rehydration Solutions
Splenic Artery
Fluid Therapy
Interleukin-8
Intravenous Administration
Population
Monocytes
Blood Cells
Neutrophils
Swine
Salts
Biomarkers
Hemodynamics
Western Blotting
Cytokines
T-Lymphocytes

Keywords

  • Cytokines
  • Enteral fluids
  • Inflammation
  • Innate immunity
  • Spleen
  • Thermal injury
  • White blood cells

ASJC Scopus subject areas

  • Surgery
  • Emergency Medicine
  • Critical Care and Intensive Care Medicine

Cite this

Gómez, B. I., Harrington, B. K., Chao, T., Chung, K. K., Dubick, M. A., Boggs, N. A., & Burmeister, D. M. (Accepted/In press). Impact of oral resuscitation on circulating and splenic leukocytes after burns. Burns. https://doi.org/10.1016/j.burns.2019.08.019

Impact of oral resuscitation on circulating and splenic leukocytes after burns. / Gómez, Belinda I.; Harrington, Brenna K.; Chao, Tony; Chung, Kevin K.; Dubick, Michael A.; Boggs, Nathan A.; Burmeister, David M.

In: Burns, 01.01.2019.

Research output: Contribution to journalArticle

Gómez, BI, Harrington, BK, Chao, T, Chung, KK, Dubick, MA, Boggs, NA & Burmeister, DM 2019, 'Impact of oral resuscitation on circulating and splenic leukocytes after burns', Burns. https://doi.org/10.1016/j.burns.2019.08.019
Gómez BI, Harrington BK, Chao T, Chung KK, Dubick MA, Boggs NA et al. Impact of oral resuscitation on circulating and splenic leukocytes after burns. Burns. 2019 Jan 1. https://doi.org/10.1016/j.burns.2019.08.019
Gómez, Belinda I. ; Harrington, Brenna K. ; Chao, Tony ; Chung, Kevin K. ; Dubick, Michael A. ; Boggs, Nathan A. ; Burmeister, David M. / Impact of oral resuscitation on circulating and splenic leukocytes after burns. In: Burns. 2019.
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abstract = "Background: Hemodynamic aberrations after severe burns are treated with aggressive intravenous (IV) fluid resuscitation however, oral resuscitation has been proposed in resource poor scenarios. Previously we have shown that animals receiving oral fluid following burns were able to recover kidney function. However, immune function such as circulating and splenic immune cell populations after oral or intravenous fluid administration was not examined. Herein, we perform a follow up analysis of splenic tissue and plasma from the previous animal study to examine the splenic response following these resuscitation strategies after burn injury. Methods: Eighteen anesthetized Yorkshire swine receiving 40{\%}TBSA contact burns were randomized to receive either: (1) no fluids (Fluid Restricted; negative control), (2) 70 mL/kg/d Oral Rehydration Salt solution (Oral), or (3) 2 mL/kg/{\%}TBSA/d of lactated Ringer's solution IV. Blood was drawn for blood cell analysis, and CT scans were performed before and 48 h post-burn, at which point spleens were harvested for histological, Western blot, and RT-PCR analyses. Results: Splenic artery diameter decreased by −0.97 ± 0.14 mm in fluid-restricted animals, while IV led to an increase of 0.68 ± 0.30 mm. No significant differences were detected in white and red pulp. IV fluids reduced the population of splenic monocytes (CD163; P = 0.001) and neutrophils (MPO protein; P = 0.13), as well as cytokines IL-8 (P = 0.003), IFN-γ (P = 0.11) and TNFα (P = 0.05). Additionally, withholding IV fluids consistently decreased the expression of FoxP3, CCR6, and IL17β in spleen, suggesting a shift in T-cell phenotype with IV resuscitation. Conclusions: The route of fluid administration has a minor influence on the changes in circulating and splenic leukocytes post-burn in the acute phase. Further research is needed to help guide resuscitation approaches using immunologic markers of splenic function following burns.",
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AU - Gómez, Belinda I.

AU - Harrington, Brenna K.

AU - Chao, Tony

AU - Chung, Kevin K.

AU - Dubick, Michael A.

AU - Boggs, Nathan A.

AU - Burmeister, David M.

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N2 - Background: Hemodynamic aberrations after severe burns are treated with aggressive intravenous (IV) fluid resuscitation however, oral resuscitation has been proposed in resource poor scenarios. Previously we have shown that animals receiving oral fluid following burns were able to recover kidney function. However, immune function such as circulating and splenic immune cell populations after oral or intravenous fluid administration was not examined. Herein, we perform a follow up analysis of splenic tissue and plasma from the previous animal study to examine the splenic response following these resuscitation strategies after burn injury. Methods: Eighteen anesthetized Yorkshire swine receiving 40%TBSA contact burns were randomized to receive either: (1) no fluids (Fluid Restricted; negative control), (2) 70 mL/kg/d Oral Rehydration Salt solution (Oral), or (3) 2 mL/kg/%TBSA/d of lactated Ringer's solution IV. Blood was drawn for blood cell analysis, and CT scans were performed before and 48 h post-burn, at which point spleens were harvested for histological, Western blot, and RT-PCR analyses. Results: Splenic artery diameter decreased by −0.97 ± 0.14 mm in fluid-restricted animals, while IV led to an increase of 0.68 ± 0.30 mm. No significant differences were detected in white and red pulp. IV fluids reduced the population of splenic monocytes (CD163; P = 0.001) and neutrophils (MPO protein; P = 0.13), as well as cytokines IL-8 (P = 0.003), IFN-γ (P = 0.11) and TNFα (P = 0.05). Additionally, withholding IV fluids consistently decreased the expression of FoxP3, CCR6, and IL17β in spleen, suggesting a shift in T-cell phenotype with IV resuscitation. Conclusions: The route of fluid administration has a minor influence on the changes in circulating and splenic leukocytes post-burn in the acute phase. Further research is needed to help guide resuscitation approaches using immunologic markers of splenic function following burns.

AB - Background: Hemodynamic aberrations after severe burns are treated with aggressive intravenous (IV) fluid resuscitation however, oral resuscitation has been proposed in resource poor scenarios. Previously we have shown that animals receiving oral fluid following burns were able to recover kidney function. However, immune function such as circulating and splenic immune cell populations after oral or intravenous fluid administration was not examined. Herein, we perform a follow up analysis of splenic tissue and plasma from the previous animal study to examine the splenic response following these resuscitation strategies after burn injury. Methods: Eighteen anesthetized Yorkshire swine receiving 40%TBSA contact burns were randomized to receive either: (1) no fluids (Fluid Restricted; negative control), (2) 70 mL/kg/d Oral Rehydration Salt solution (Oral), or (3) 2 mL/kg/%TBSA/d of lactated Ringer's solution IV. Blood was drawn for blood cell analysis, and CT scans were performed before and 48 h post-burn, at which point spleens were harvested for histological, Western blot, and RT-PCR analyses. Results: Splenic artery diameter decreased by −0.97 ± 0.14 mm in fluid-restricted animals, while IV led to an increase of 0.68 ± 0.30 mm. No significant differences were detected in white and red pulp. IV fluids reduced the population of splenic monocytes (CD163; P = 0.001) and neutrophils (MPO protein; P = 0.13), as well as cytokines IL-8 (P = 0.003), IFN-γ (P = 0.11) and TNFα (P = 0.05). Additionally, withholding IV fluids consistently decreased the expression of FoxP3, CCR6, and IL17β in spleen, suggesting a shift in T-cell phenotype with IV resuscitation. Conclusions: The route of fluid administration has a minor influence on the changes in circulating and splenic leukocytes post-burn in the acute phase. Further research is needed to help guide resuscitation approaches using immunologic markers of splenic function following burns.

KW - Cytokines

KW - Enteral fluids

KW - Inflammation

KW - Innate immunity

KW - Spleen

KW - Thermal injury

KW - White blood cells

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