Are units from Europe and North America and emphasized a direct correlation between glutamine administration and MODS incidence. [39]. Aksu et al., explained the benefits of volume resuscitation when using gluconate – balanced crystalloid which prevent hyperchloraemic acidosis, anion gap and renal hypoperfusion [40]. They highlighted the decline in tissue inflammation but also the increase of favorable parameters for volume and electrolyte balance [40]. Another intense studied compound is decay accelerating factor (CD55/ DAF) [30]. It is a membrane protein that has enzymatic action , protecting the cells of antologous complement activation. Lucca et al., conducted a study in whichTable 1 Fluid resuscitation studiesAuthor O’Malley et al. Maitland et al. Shaw et al. Annane et al. Rasmussen et al. Abeed et al. Type of fluid NaCl 0.9 , respective lactated Ringer Albumine, respective NaCl 0.9 NaCl 0.9 , respective balanced crystalloid Comparison between colloids and cristaloides. Studied the effects of HES 130/0.4 upon coagulation Studied the renal function after NaCl 0.9 vs. Plasma-Lyte 148 Observationshemorrhagic shock resuscitation was performed using recombinant human DAF. Histological analysis demonstrated that the use of DAF (50 mg/kg) in volume replacement PubMed ID:http://www.ncbi.nlm.nih.gov/pubmed/26780312 solutions reduce particulary renal and hepatic injuries. In addition to these benefits, the use of DAF reduces the need for fluids and prevents inflammatory responses and coagulopathy [30]. A biologically active compound used in combination with fluids is valproic acid [41]. Hemorrhagic shock blocks histone acetyltransferase activity, suppressing gene transcription. Valproic acid acts upon histone deacetylase inhibitor [41, 42]. Glycogen Synthase Kinase (GSK) [43, 44] is a biologically active substance used in the management of fluid resuscitation. This enzyme regulates a number of cellular functions protein synthesis, cell differentiation and cell motility. Overexpression of GSK lead to an extremely complex inflammatory phenomenon [43]. Recent studies show that by blocking the activity of GSK-3-Beta, inflammation and hepatocellular injury markers decrease significantly. To inhibit the activity of this enzyme, Jellestad et al., used two agents: 4-benzyl-2-methyl1,2,4-thiadizolidine 3,5-diones (TDZD-8) [34] and domethyl sulfoxide (DMSO). In the study they demonstrated that inhibition of GSK-3-Beta enzyme leads to increased liver function and Cibinetide side effects microcirculation [43].Fluid resuscitation and inflammatory and redox statusFluid management in trauma patients is extensively studied, and controversies regarding side effects, inflammatory response and tissue hypoxia further complicate the clinical decisions. Table 1 presents studies related to fluid management in critical patients. German Society for Trauma Surgery recommends using Ringer’s solution acetated or malate Ringer’s solution before the start of volume resuscitation. The metabolism of acetate prevents hyperchloraemic acidosis, being metabolized to carbon dioxide and water. Meanwhile, acetate molecule can be metabolized in gluconeogenesis, forming bicarbonate ion (HCO-). For each functional group in 3 acetate molecule (COOH), one HCO- molecule isReference [65] [66] [67] [68] [69] [70]They noticed that when using lactated Ringer solution, the incidence of patients with hyperkalemia decreases, as well as incidence of acidosis. In both cases there was an increase in mortality rate. When using NaCl 0.9 there was an increase in mort.
