Damage-Associated Molecular Patterns (DAMPs) in Resuscitated Hemorrhagic Shock Are Mitigated by Peritoneal Fluid Administration

Introduction: Conventional resuscitation (CR) of hemorrhagic shock (HS), a significant cause of trauma mortality, is I.V. blood and fluids. CR restores central hemodynamics, but vital organ flow can drop causing hypoperfusion, hypoxia, Damage-Associated Molecular Patterns (DAMPs), and remote organ dysfunction (i.e., lung). CR plus Direct Peritoneal Resuscitation (DPR) prevents intestinal and hepatic hypoperfusion. We hypothesized that DPR prevents lung injury in HS/CR by altering DAMPs. Methods: Anesthetized male SD rats were randomized to groups (n=8/group) in one of two sets: 1) Sham (no HS, CR, or DPR); 2) HS/CR (HS=40% MAP for 60min, CR=shed blood + 2 volumes NS); or 3) HS/CR+DPR. First set underwent whole lung blood flow by colorimetric microspheres. Second set underwent tissue collection for Luminex, ELISAs, and histopathology. Lipopolysaccharide (LPS) and DAMPs were measured in serum and/or lung including cytokines, hyaluronic acid (HA), high mobility group box 1 (HMGB1), toll-like receptor 4 (TLR4...