Uso de solución salina hipertónica al 3 por ciento en niños con bronquiolitis aguda / Usage of 3 percent Hypertonic Saline Solution in Children with Acute Bronchitis

Introducción: La bronquiolitis aguda es la infección del tracto respiratorio inferior más frecuente en el lactante. Tiene una incidencia anual del 10 por ciento en los lactantes y una tasa de ingreso de entre el 2 y el 5 por ciento con un incremento importante en los últimos años. Objetivo: Determinar la efectividad del uso de solución salina hipertónica al 3 por ciento nebulizada en pacientes con bronquiolitis aguda. Métodos: Se realizó un estudio analítico longitudinal prospectivo de tipo casos y controles. El universo estuvo constituido por 132 pacientes distribuidos en 66 casos y 66 controles. Resultados: La edad media fue de 3,6 ± 2,5 meses. Los sibilantes se hallaron en 129 pacientes, lo que representó el 97,7 por ciento. Se encontró una estadía hospitalaria media de 3,19 ± 1,41 días en los casos, mientras que en los controles se encontró una media de 4,97 ± 1,77 días, diferencia que resultó altamente significativa (p < 0,001). Conclusiones: Aunque los pacientes tratados con solución salina hipertónica al 3 por ciento necesitaron más días con oxigenoterapia, el tratamiento resultó ser efectivo al mostrar una menor estadía hospitalaria y un menor número de complicaciones en pacientes con bronquiolitis aguda(AU)

Introduction: Acute bronchiolitis is the most frequent lower respiratory tract infection in the infant. It has a yearly incidence of 10 percent in infants and an admission rate of 2 percent to 5 percent, with a significant increase in recent years. Objective: To determine the effectiveness of nebulized 3 percent hypertonic saline solution treatment in patients with acute bronchiolitis. Methods: A prospective, longitudinal and analytical study of case-control design was carried out. The universe consisted of 132 patients distributed into 66 cases and 66 controls. Results: The mean age was 3.6±2.5 months. Wheezing was found in 129 patients, accounting for 97.7 percent. A mean hospital stays of 3.19±1.41 days was found in cases, while a mean of 4.97±1.77 days was found in controls, a difference that was highly significant (P<0.001). Conclusions: Although patients treated with 3 percent hypertonic saline solution required more days with oxygen therapy, the treatment proved to be effective by showing a shorter hospital stay and a lower number of complications in patients with acute bronchiolitis(AU)

Uso de Solución Hipertónica en pacientes con insuficiencia cardiaca aguda como terapia adyuvante a altas dosis de diuréticos / Use of Hypertonic Solution in patients with acute heart failure as adjunctive therapy to high-dose diuretics

Resumen La insuficiencia cardíaca aguda descompensada (ICAD) es una causa común de hospitalización, con repercusiones significativas en los sistemas de salud. El manejo agudo se basa en la reducción de la volemia con diuréticos de asa, sin embargo, un porcentaje de pacientes presenta resistencia o no logra la respuesta clínica esperada con este tratamiento. Una de las medidas que ha comprobado ser efectiva en este contexto, es el uso de solución salina hipertónica (SSH) en conjunto con dosis altas de diuréticos de asa, como medida terapéutica temida por sus posibles repercusiones sobre la función renal y posible sobrecarga de sodio. Objetivos: Determinar si el uso de solución salina hipertónica en pacientes con falla cardiaca aguda e hipervolemia genera un deterioro de la función renal. Determinar la respuesta del Pro-BNP ante el uso de la solución salina hipertónica en pacientes con falla cardiaca aguda como marcador de respuesta terapéutica. Determinar si el uso de solución salina hipertónica aumenta la diuresis sin generar cambios importantes en el sodio. Se muestran datos de pacientes con insuficiencia cardiaca aguda descompensada, que tras no presentar mejoría con altas dosis de diurético de asa en bolo, se les aplicó la solución hipertónica como adyuvante a este tratamiento. Se toma un total de 26 pacientes analizando datos generales clínicos y de laboratorio, se valoran curvas con la respuesta diurética y por parámetros de laboratorio a las 48 y 72 horas. El uso de solución salina hipertónica consigue un aumento de más de un 200% de la diuresis en 24 horas, con un descenso del Pro BNP de más de un 60% a las 48 horas, sin mostrar un cambio importante en los niveles de creatinina, nitrógeno ureico y sodio. Se requirió reposición de potasio en la totalidad de los pacientes. Se concluye que la infusión de furosemida más solución hipertónica es efectiva tanto en disminuir niveles de NT Pro-BNP en los pacientes, como en generar un aumento en el volumen de diuresis. La principal complicación fue la hipokalemia, sin cambios considerables en el valor de sodio, creatinina y nitrógeno ureico séricos.

Abstract Uso de Solución Hipertónica en pacientes con insuficiencia cardiaca aguda como terapia adyuvante a altas dosis de diuréticos Acute decompensated heart failure (AHF) is a common cause of hospitalization, with significant repercussions on health systems. Acute management is based on the reduction of blood volume with loop diuretics; however, a percentage of patients show resistance or do not achieve the expected clinical response with this treatment. One of the measures that has proven to be effective in this context is the use of hypertonic saline (HSS) in conjunction with high doses of loop diuretics, as a therapeutic measure feared due to its possible repercussions on kidney function and possible sodium overload. Objetives: To determine if the use of hypertonic saline in patients with acute heart failure and hypervolemia leads to a deterioration in renal function. To determine the response of Pro-BNP to the use of hypertonic saline in patients with acute heart failure as a marker of therapeutic response. Determine if the use of hypertonic saline increases urine output without causing significant changes in sodium. Data are shown from patients with acute decompensated heart failure, who after not presenting improvement with high doses of bolus loop diuretic, the hypertonic solution was applied as an adjunct to this treatment. A total of 26 patients are taken analyzing general clinical and laboratory data, curves with the diuretic response and by laboratory parameters are evaluated at 48 and 72 hours. The use of hypertonic saline solution achieves an increase of more than 200% in diuresis in 24 hours, with a decrease in Pro BNP of more than 60% at 48 hours, without showing a significant change in creatinine levels, urea nitrogen and sodium. Potassium replacement was required in all patients. It is concluded that the infusion of furosemide plus hypertonic solution is effective both in reducing levels of NT Pro-BNP in patients, and in generating an increase in the volume of diuresis. The main complication was hypokalemia, without significant changes in serum sodium, creatinine, and urea nitrogen.

Randomized trial of physiotherapy and hypertonic saline techniques for sputum induction in asthmatic children and adolescents

OBJECTIVES: This study aimed to analyze the efficiency of physiotherapy techniques in sputum induction and in the evaluation of pulmonary inflammation in asthmatic children and adolescents. Although hypertonic saline (HS) is widely used for sputum induction (SI), specific techniques and maneuvers of physiotherapy (P) may facilitate the collection of mucus in some asthmatic children and adolescents. METHODS: A randomized crossover study was performed in patients with well-controlled asthma, and 90 sputum samples were collected. Children and adolescents were assessed using spirometry and randomized at entry into one of three sputum induction techniques: (i) 3% hypertonic saline - HS technique; (ii) physiotherapy (oscillatory positive expiratory pressure, forced expiration, and acceleration of expiratory flow) - P technique; and (iii) hypertonic saline + physiotherapy - HSP technique. ClinicalTrials.gov: NCT03136042. RESULTS: The total cells (mL) and the percentage (%) of differential inflammatory cells were similar in all techniques. The sputum weight (g) in the HSP technique was significantly higher than that in the HS technique. In all techniques, the percentage of viable cells was >50%, and there was no difference between the HS and P techniques. Moreover, sputum induction did not cause any alterations in the pulmonary function of patients. CONCLUSION: The physiotherapy sputum collection technique was effective in obtaining viable cells from mucus samples and yielded the same amount of sputum as the gold standard technique (hypertonic saline). In addition, the physiotherapy maneuvers were both safe and useful for sputum induction in asthmatic children and adolescents with well-controlled asthma.

Soluções salinas em diferentes temperaturas e concentrações melhoram o pico de fluxo inspiratório nasal em escolares? / Do saline solutions at different temperatures and concentrations improve peak nasal inspiratory flow in students?

Introdução: A higiene nasal com solução salina mostrou aliviar a congestão, manter a cavidade nasal limpa e úmida e reduzir o espessamento do muco. Evidências que apoiam solução salina aquecida ou solução salina à temperatura ambiente, em diferentes concentrações, são controversas. Objetivo: Avaliar se soluções salinas aquecidas, em diferentes concentrações, são melhores que soluções salinas em temperatura ambiente para aumentar o fluxo inspiratório nasal em crianças saudáveis. Métodos: Estudantes entre 8 e 12 anos de idade foram submetidos a quatro procedimentos com soluções salinas em diferentes concentrações e temperaturas. O pico de fluxo inspiratório nasal foi medido antes e 30 minutos após cada procedimento. A análise estatística foi realizada por meio do teste t de Student, considerando p < 0,05. Resultados: Avaliamos 46 crianças em todas as etapas, cada criança foi controle de si mesma. Solução salina a 3% apresentou melhores resultados, mas não houve diferença significativa no pico de fluxo inspiratório nasal quando comparadas solução salina a 0,9% e solução salina a 3%, aquecida ou em temperatura ambiente. Quando perguntado, as crianças prefeririam solução salina a 0,9% e aquecida. Conclusão: A solução salina a 3% apresentou maiores médias de pico de fluxo inspiratório nasal, mas não foi significativamente superior à solução salina a 0,9%. A solução salina aquecida não foi superior à solução salina em temperatura ambiente. É importante oferecer várias opções aos pacientes.

Introduction: Nasal hygiene with saline has been shown to relieve congestion, keep nasal cavity clean and moist, and reduce thickened mucus. Evidence supporting warmed saline or room temperature saline at different concentrations are controversial. Objective: To evaluate whether warmed saline at different concentrations is better than room temperature saline for improving peak nasal inspiratory flow in healthy children. Methods: Students between 8 and 12 years of age underwent 4 procedures with saline solutions at different concentrations and temperatures. Peak nasal inspiratory flow was measured before and 30 minutes after each procedure. Statistical analysis was performed using Student's t-test, with p < 0.05. Results: We evaluated 46 children at all stages, and each child was self-controlled. Three percent saline had better results, but there was no significant difference in peak nasal inspiratory flow when compared to 0.9% saline, either warmed or at room temperature. Children reported preferring warmed 0.9% saline. Conclusion: Three percent saline had higher mean nasal inspiratory peak flow, but it was not significantly different from 0.9% saline. Warmed saline was not superior to room temperature saline. Providing patients with various options is important.

Comparison of the effects of volemic reposition with 7. 5 % NaCl or blood in an experimental model of muscular compression and hemorrhagic shock / Comparação dos efeitos da reposição volêmica com NaCl 7, 5 % ou sangue em um modelo experimental de compressão muscular e choque hemorrágico

ABSTRACT Objective: Crush syndrome is characterized by traumatic muscular injuries with severe systemic clinical repercussions. The systemic inflammatory reaction characterized acutely by infiltration of neutrophils in the lungs has been studied as part of the spectrum of crush syndrome. Experimental research may demonstrate alternative treatments for crush syndrome. The authors studied the hypothesis that hypertonic saline solution (7.5% NaCl) could minimize the local and systemic effects in a model of muscular compression and hemorrhagic shock. Methods: Rabbits were submitted to a new model of muscle compression associated with hemorrhagic shock. Compression was applied through an Esmarch bandage, used for 1 h on the entire right lower limb. Hemorrhagic shock was induced for 1 h by dissection and catheterization of the carotid artery. Blood replacement or hypertonic saline solution was used to treat the shock. Biochemical analysis of plasma, quantification of muscular edema, and infiltration of inflammatory cells in the lungs were carried out. Results: Animals treated with hypertonic solution presented the same hemodynamic response as the blood treated patients, less water in the compressed muscles and less infiltration of inflammatory cells in the lungs. The blood group presented hypocalcemia, a facet of crush syndrome. Conclusions: The proposed model was effective for the study of crush syndrome associated with hemorrhagic shock. The treatment with hypertonic solution showed benefits when compared with blood volume replacement.

RESUMO Objetivo: A síndrome de esmagamento é caracterizada por lesões musculares traumáticas com graves repercussões clínicas sistêmicas. A reação inflamatória sistêmica, caracterizada agudamente por infiltração de neutrófilos nos pulmões, tem sido estudada como parte do espectro da síndrome de esmagamento. A pesquisa experimental pode demonstrar opções de tratamento para a síndrome de esmagamento. Os autores estudaram a hipótese de que solução salina hipertônica (NaCl 7,5%) pudesse minimizar os efeitos locais e sistêmicos da síndrome de esmagamento em um modelo de compressão muscular e choque hemorrágico. Métodos: Coelhos foram submetidos a um novo modelo de compressão muscular associado ao choque hemorrágico. A compressão foi feita por uma faixa de Esmarch aplicada por uma hora em todo membro inferior direito. O choque hemorrágico foi induzido durante uma hora por dissecção e cateterização da artéria carótida. O choque foi tratado com reposição de sangue ou solução salina hipertônica. Foram feitas análises bioquímicas do plasma, quantificação do edema muscular e infiltração de células inflamatórias nos pulmões. Resultados: Os animais tratados com solução hipertônica apresentaram a mesma resposta hemodinâmica observada naqueles tratados com sangue, menor quantidade de água nos músculos comprimidos e menor infiltração de células inflamatórias nos pulmões. O grupo tratado com sangue apresentou hipocalcemia, característica da síndrome de esmagamento. Conclusões: O modelo proposto mostrou-se efetivo para o estudo da síndrome de esmagamento associada ao choque hemorrágico. O tratamento com solução hipertônica apresentou benefícios quando comparado com a reposição volêmica com sangue.

Effects of hypertonic saline vs normal saline on lactate clearance after cardiovascular surgery / Efectos del salino hipertónico versus el salino normal en la depuración de lactato después de cirugía cardiovascular

Abstract Background: The postoperative care of patients subjected to cardiac surgery frequently require a complete recovery with intravenous fluids, but crystalloid solutions like normal saline may increase the interstitial oedema, and it is also well known that fluid overload increases mortality. Objective: To compare the effect of 7.5% hypertonic saline (HS) with 0.9% normal saline (NS) on lactate clearance, as well as the haemodynamic response of patients during the first day after cardiovascular bypass surgery. Methods: The study included patients 18 years of age and older with coronary artery disease and/or heart valve disease, and who underwent bypass surgery and/or cardiac valve replacement and were randomly assigned to receive 4 mL/kg of HS or NS intravenously for 30 min once they were admitted to the ICU. Lactate, arterial blood gases, heart rate, central venous pressure, and pulmonary wedge pressure were measured at 0, 6, 12, and 24 h after being admitted to the ICU. The analyses were carried out with an intention-to-treat principle. Results: Out of a total of 494 patients evaluated, 102 were included and assigned to the HS groups (51 patients) or NS (51 patients). The mean age of the participants was 59 ± 14 years, and 59.8% were male. No statistically significant differences were observed between two groups in the lactate clearance, or in any of the secondary outcomes. Conclusions: Our study failed to show a better lactate clearance in the group on hypertonic saline, and with no evidence of a higher incidence of adverse effects in that group. © 2017 Instituto Nacional de Cardiología Ignacio Chávez. Published by Masson Doyma México S.A. This is an open access article under the CC BY-NC-ND license (https://creativecommons.org/licenses/by-nc-nd/4.0/).

Resumen Introducción: El cuidado postoperatorio de pacientes sometidos a cirugía cardíaca requiere frecuentemente una reanimación completa con líquidos intravenosos, pero las soluciones cristaloides pueden incrementar el edema intersticial y la sobrecarga de líquidos incrementa la mortalidad. Objetivo: Comparar el efecto del salino hipertónico (SH) al 7.5% con respecto al salino normal (SN) del 0.9% en la depuración de lactato y la respuesta hemodinámica durante el primer día postoperatorio de pacientes con cirugía cardiovascular con circulación extracorpórea. Métodos: Pacientes mayores de 18 años con cirugía de arterias coronarias o de enfermedad valvular cardíaca fueron aleatorizados a recibir 4 ml/kg de SH o SN intravenosos en los primeros 30min de admisión a UCI. Se midieron los valores de lactato, estado ácido-base, frecuencia cardíaca, presión venosa central y presión en cuña pulmonar a las horas 0, 6, 12 y 24 después del ingreso a UCI. Se hizo un análisis con el principio de intención de tratar para un modelo de datos longitudinales. Resultados: Se evaluaron 494 pacientes y se aleatorizaron 102 a los grupos de SH (n = 51) o SN (n = 51). El promedio de edad fue 59 ± 14 años y el 59.8% fueron hombres. No se observó ninguna diferencia estadísticamente significativa entre los 2 grupos en la depuración de lactato o en cualquiera de los desenlaces secundarios. Conclusiones: Nuestro estudio no mostró mejor depuración de lactato con el uso de una dosis de SH ni mayor frecuencia de efectos adversos en ese grupo. © 2017 Instituto Nacional de Cardiología Ignacio Chávez. Publicado por Masson Doyma México S.A. Este es un artículo Open Access bajo la licencia CC BY-NC-ND (https://creativecommons.org/licenses/by-nc-nd/4.0/).

Multivariate analysis of efifcacy of nebulized inhalation of 3%hypertonic saline in pediatric inpatient with bronchiolitis / 临床儿科杂志

Objective To evaluate the efifcacy and inlfuencing factors of 3%hypertonic saline (HS) inhalation in treatment of bronchiolitis. Methods Clinical data together with the detection of 16 types of respiratory tract virus from hospitalized pediatric patients with primary diagnosis of bronchiolitis from June 2009 to December 2012 were retrospectively analyzed. The endpoint indicators for evaluation on the efifcacy of nebulized 3%HS inhalation were the percent decrease of clinical severity (CS) score after 2 days' treatment and the hospitalization time. Factors affecting efifcacy were further explored. Results The CS score in nebulized 3%HS treated group decreased in average of 42.86%(11.11%-66.67%), signiifcantly higher than that (26.79%, 0.00%-50.00%) in the untreated group (P=0.006). No difference of between the two groups (P=0.26). Multiple linear regression analysis showed that nebulized 3%HS inhalation has better efifcacy on the patients older than 3 months having breastfeeding, respiratory synthetic syncytial virus (RSV) infection and extensive wheezing sound auscultation of the lungs. The multiple linear regression analysis model was statistically signiifcant (R2=0.58, P<0.001). Conclusions After 2 days' treatment with 3%hypertonic saline inhalation, the CS score of bronchiolitis patients was decreased. The treatment can be recommended in hospitalized patient older than 3 months with breastfeeding, RSV infection, and extensive wheezing sound auscultation of the lungs.

Manitol versus solución salina hipertónica en neuroanestesia / Mannitol versus hypertonic saline solution in neuroanaesthesia

Background: Hyperosmolar therapy with mannitol or hypertonic saline solution is the main medical strategy for the clinical management of intracranial hypertension (IH) and cerebral oedema. IH and cerebral oedema are usually the result of acute and chronic brain injuries such as severe head trauma, ischaemic stroke, intracerebral haemorrhage, aneurismal subarachnoid haemorrhage, tumours and cerebral infections. Objective: We conducted this research in order to assess the benefits and side effects of osmotherapy and to identify the current trends in the management of IH and cerebral oedema. These two conditions worsen neurological outcomes and are the major cause of mortality in neurological patients. In this article we show the current evidence supporting the use of HTS and mannitol, and examine the question of which of the two agents is considered the best option for the medical treatment of IH. We review the efficacy data for HTS compared with mannitol in terms of clinical considerations. Conclusion: Data availability is limited because of small sample sizes, inconsistent methods and few prospective randomized comparative studies, although both agents are effective and have a reasonable risk profile for the treatment of cerebral oedema and IH. Currently, several trials show that HTS could be more effective in reducing ICP, with longer lasting effects. HTS maintains systemic and cerebral haemodynamics.

Antecedentes: La terapia hiperosmolar con manitol o solución salina hipertónica (SSH) es la principal estrategia médica para el manejo clínico de la hipertensión intracraneal (HIC) y del edema cerebral. La HIC y el edema cerebral suelen ser las consecuencias de lesiones cerebrales agudas y crónicas tales como el trauma craneoencefálico severo, el accidente cerebrovascular isquémico, la hemorragia intracerebral, la hemorragia subaracnoidea aneurismática, y los tumores e infecciones cerebrales. Ambas entidades, contribuyen a peores resultados neurológicos y producen mayor mortalidad en los pacientes neurocríticos. Objetivo: Realizamos esta investigación con el objetivo de valorar lo efectos beneficiosos y secundarios de la osmoterapia y cuáles son las tendencias actuales para el manejo de la HIC y del edema cerebral. En el presente artículo mostramos la evidencia actual que soporta a la SSH y al manitol y cuál se considera la mejor opción como terapia médica en el tratamiento de la HIC. Revisamos la eficacia de los datos para SSH frente a manitol hablando sobre sus consideraciones clínicas. Conclusión: La disponibilidad de los datos es imitada por las muestras pequeñas, métodos inconsistentes y pocos estudios aleatorizados prospectivos comparativos, y aunque ambos agentes son eficaces y tienen un perfil de riesgo razonable para el tratamiento del edema cerebral y en la HIC, en la actualidad varios ensayos demuestran que la SSH podría ser más eficaz en la reducción de la PIC y por más tiempo. La SSH mantiene la hemodinamia sistémica y cerebral.

Effect of compound hypertonic saline solution on septic rats / 中华危重病急救医学

Objective To study the effect of compound hypertonic saline solution (HSD) on sepsis.Methods 133 male Wistar rats were divided into four groups,sham operation group (n =15),cecal ligation and puncture (CLP)group (n =45),CLP plus normal saline (NS) group (n =45),and CLP plus HSD group (n =28).A rat model of sepsis was reproduced by CLP,and the rats in sham operation group received celiotomy without ligation and puncture.All rats in four groups received subcutaneous injection of 30 mL/kg 0.9％ sodium chloride after laparotomy.The rats in CLP plus NS group and CLP plus HSD group received infusion of 5 mL/kg 0.9％ sodium chloride or 7.5％ sodium chloride/6％ dextran post CLP via jugular vein for 3 hours,with the infusion rate of 0.4 mL·kg-1·min-1.The survival rate of each group was observed 9 hours and 18 hours after laparotomy.Mean arterial pressure (MAP) at 0,9,18 hours were monitored.Blood specimens were collected from all rats 0,9 and 18 hours after laparotomy,respectively,for measurement of the plasma levels of tumor necrosis factor-α (TNF-α),interleukin-1β (IL-1β),and procalcitonin (PCT).The rats were all sacrificed,and their lung tissues were harvested for the neutrophil count in bronchoalveolar lavage fluid (BALF),myeloperoxidase (MPO) activity in lung tissue,wet/dry weight ratio (W/D) of lung,and pathological changes in lung tissue.Results There was no death in the sham operation group.The survival rates at 9 hours and 18 hours were 62.2％ and 31.1％ in the CLP group,57.8％ and 35.6％ in the CLP plus NS group,85.7％ and 64.3％ in the CLP plus HSD group,and they were all significantly higher compared with those of the CLP group and the CLP plus NS group (P ＜ 0.05 or P ＜ 0.01).MAP levels in the CLP group and the CLP plus NS group were significantly lower than those in sham operation group,and the plasma levels of TNF-α,IL-1β and PCT were significantly higher compared with those of sham operation group,while there was no difference between CLP group and the CLP plus NS group.MAP and the plasma levels of TNF-α,IL-1β and PCT in the CLP plus HSD group were significantly improved compared with those of the CLP plus NS group at 9 hours and 18 hours [MAP (mmHg,1 mmHg =0.133 kPa) at 9 hours:102±5 vs.94±6,18 hours:90±2 vs.72±3; TNF-α (ng/L) at 9 hours:284.19±57.18 vs.329.67±45.79,18 hours:263.46±42.58 vs.349.68±52.40; IL-1β (ng/L) at 9 hours:219.28±39.21 vs.263.47±32.36,18 hours:195.98±39.06 vs.250.10±41.57; PCT (μg/L) at 9 hours:2.32±0.37 vs.4.52±0.75,18 hours:2.89±0.62 vs.5.02±0.84; P ＜ 0.05 or P ＜ 0.01].The ratio of neutrophils in BALF,MPO activity and lung W/D at 18 hours in the CLP group and the CLP plus NS group were significantly higher than those of the sham operation group,while they were all significantly lower in the CLP plus HSD group than those of the CLP group and the CLP plus NS group [ratio of neutrophils in BALF:0.094±0.019 vs.0.148±0.062,0.151 ±0.055; MPO (U/g):1.19±0.45 vs.2.31 ±0.79,2.64±0.69; lung W/D ratio:4.02 ± 0.63 vs.5.14 ± 0.59,5.12 ± 0.83,all P ＜ 0.05].Under light microscope,no pathobiological changes were found in sham operation group.The lung tissues in the CLP group and the CLP plus NS group showed congestion,edema,infiltrating inflammatory changes,while the inflammatory changes in the lung tissue in the CLP plus HSD group were significantly alleviated.Conclusion HSD can obviously ameliorate the circulatory failure in septic rats,alleviate immune disturbance and acute lung injury,and improve the survival rate of rats with sepsis.

Effects of 4% Hypertonic Saline Solution Mouthwash on Oral Health of Elders in Long Term Care Facilities

PURPOSE: This study was done to examine the effects of 4% hypertonic saline solution mouthwash and tooth brushing education on the oral health of elders living in long term care facilities. METHODS: In this quasi-experimental study, the participants were assigned to a 2% experimental group (n=20), a 4% experimental group (n=20), and a control group (n=20). Data were analyzed using ANOVA, repeated measures ANOVA, Fisher exact test, Chi-square test, Kruskal-Wallis test and multiple response analysis with the SAS program. RESULTS: Regular tooth brushing and use of 4% hypertonic saline solution mouthwash by elders provided better oral health by decreasing xerostomia, oral tongue plaque, halitosis, and the number of oral bacteria. CONCLUSION: The results indicate that regular tooth brushing with continuous 4% hypertonic saline solution mouth washing education promotes oral health for elders in long term care facilities, thus the dental care described in this study is recommended for elders in long term facilities.

Hypertonic saline downregulate the production level of lipopolysaccharide-induced migration inhibitory factor in THP-1 cells / 대한외과학회지

PURPOSE: Macrophage migration inhibitory factor (MIF) may serve as a general marker for systemic inflammation in septic and nonseptic acute critical illness. Additionally, our previous experiment has demonstrated that immunosuppressant Prostaglandin E2 (PGE2) lowered MIF levels and inhibited T-cells proliferation when compared to control levels. The addition of hypertonic saline (HTS) increased MIF production as compared with PGE2-stimulated T-cells in concordance with restore PGE2-suppressed T-cells proliferation. Generally, HTS has been well known for its anti-inflammatory effect so far. Therefore, the experiments were conducted to evaluate MIF after stimulating lipopolysaccharide (LPS) either in the presence or absence of HTS in monocyte, in response to early phase injury. METHODS: Human acute monocytic leukemic cell line (THP-1) cells were cultured in RPMI media, to a final concentration of 1 x 10(6) cells/mL. The effect of HTS on LPS-induced MIF was evaluated in monocyte with 1 microg/mL LPS. HTS at 10, 20 or 40 mmol/L above isotonicity was added. MIF concentrations of the supernatant were determined by enzyme-linked immunosorbent assay, and cell lysates were used for Western blots analysis to determine the MIF expression. RESULTS: MIF concentrations in the cell supernatant increased in LPS-induced cells compared to control cells. Also, levels of MIF protein expression were higher in LPS stimulating cells. However, the addition of HTS to LPS stimulated cell restored MIF concentrations and MIF expression. CONCLUSION: The role of HTS in maintaining physiological balance in human beings, at least in part, should be mediated through the MIF pathway.

Tratamiento del prolapso rectal en la infancia con infiltración de solución salina al 16.5 por ciento / Treatment of the prolapse of the rectum in childhood with 16.5 % saline solution infiltration

Introducción: cuando falla el tratamiento médico conservador en los pacientes pediátricos con prolapso rectal se impone la infiltración perirrectal con sustancias irritantes. En la década de los 90 esas infiltraciones en nuestro centro se hacían con glicerina, pero escaseó en el mercado, y ante tal problema, se buscó otro agente infiltrante alternativo. En el presente trabajo se describe la experiencia con la utilización de solución salina al 16,5 por ciento. Métodos: se realizó un estudio de intervención, longitudinal, prospectivo, experimental, del tipo ensayo clínico no controlado. Consta de una segunda parte en la que se utilizó la aleatorización con un grupo control para la validación. El universo estuvo constituido por 27 pacientes y la muestra, por 16 pacientes con prolapso rectal, que fueron atendidos en el servicio de gastroenterología del Hospital Pediátrico Provincial de Holguín en el quinquenio 2003-2007. Las variables desarrolladas fueron: concentración idónea para el tratamiento, cantidad de sustancia a infiltrar, complicaciones, recurrencia, número de infiltraciones y curación al año o más. Los resultados se exponen en forma de tablas porcentuales. Resultados: la eficacia con la utilización de solución salina al 16,5 por ciento fue del 100 por ciento, todos los pacientes curaron, y ninguno presentó recurrencia, por lo que no fueron necesarias 2 o más sesiones de tratamiento. Se comentó de un niño que, luego de fallar la infiltración con leche materna en primera opción y fallido también el cerclaje, finalmente resolvió con este método. Las complicaciones fueron relativamente pocas (18,9 por ciento): un absceso, una celulitis y una retención urinaria con necesidad de sondaje durante 2 semanas, sin secuelas posteriores. Se realizó aleatorización con ..

Introduction: when the conservative medical treatment fails in children with prolapse of the rectum it is necessary the perirrectal infiltration with irritant substances. In 1990s these infiltrations in our center were carried out using glycerin, but due to be scarce in the market we must to find other alternative infiltrating agent. The objective of present paper is to describe the experience with the use of 16,5 percent saline solution. Methods: an experimental, prospective, longitudinal and interventional study of non-controlled clinical trial was conducted. It consists of a second part in which we used the randomization with a control group for validation. Universe included 27 patients and sample included 16 patients with prolapse of the rectum over 2003-2007, seen in service of gastroenterology of the Provincial Children Hospital of HolguÝn province. The variables developed were: a concentration suitable for treatment, amount of substance to be infiltrated, complications, recurrence, number of infiltrations and the cure at a year. Results are showed in percentage tables. Results: the effectiveness of the 16,5 percent saline solution was of 100 percent, all patients cured and any had relapse, thus there were not necessary two or more treatment sessions. There was a comment on a child that, after failure of breast milk infiltration like a first option and also of the cerclage, finally, resolved with this method. Complications were relatively few (18,9 percent): an abscess, a cellulitis and a urinary retention being necessary a catheterization for 2 weeks without subsequent sequelae. A randomization with the same number of patients was carried out using glycerin, where the use results of both substances were very similar and the number of complications was slightly

Comportamiento hidroelectrolitico y acidobásico con el empleo de soluciones salinas ligeramente hipertonicas en neurocirugía

Introducción: El empleo se solución salina normal, ligeramente hipertónica respecto al plasma, puede incrementar el gradiente osmótico y reducir los líquidos en órganos macizos (cerebro, hígado, corazón, riñones), pero también puede producir alteraciones en el balance hidroelectrolítico y acido-básico. Objetivo: Determinar el comportamiento hidroelectrolítico y ácido básico en el paciente neuroquirúrgico con el empleo de soluciones salinas con diferente grado de tonicidad. Material y método: Se realizó un estudio comparativo, observacional y transversal en 24 pacientes tratados quirúrgicamente de forma intracraneal electiva, en el periodo comprendido de enero a junio del 2009, en el Hospital «Manuel Ascunce Domenech¼ de Camagüey. Los pacientes se asignaron aleatoriamente en tres grupos, con 8 pacientes cada uno. En el primero se empleó como solución de mantenimiento cloruro de sodio al 0,9 %, en el segundo cloruro de sodio al 1.1 % y en el tercero solución salina al 1.3 %, en todos los pacientes se empleo la misma técnica neuroanestésica. Las variables utilizadas fueron las determinaciones séricas de electrolitos sodio, potasio y cloro, la osmolaridad plasmática, ph, PaCO2, y bicarbonato estándar, expresándose los resultados en tabla. Resultados: La osmolaridad sérica y los electrolitos mesurados se mantuvieron dentro de parámetros normales en la mayoría de los pacientes. La alcalosis respiratoria presente no estuvo en relación con el uso de las soluciones de cloruro de sodio, sino con la hiperventilación. Conclusiones: Con el empleo de las tres soluciones no existieron desórdenes importantes del equilibrio hidroelectrolítico y acido base, en la mayoría de los pacientes.

Introduction: Use of normal saline solution slightly hypertonic regarding the plasma, may to increase the osmotic gradient and to reduce the presence of fluids in solid organs (brain, liver, heart, kidneys) but also may to produce alterations in hydroelectrolytic and acid-base balance. Objective: To determine the hydroelectrolytic and acid-base behavior related to use of saline solutions with different tonicity degree. Material and Method: A cross-sectional, observational and comparative study was conducted in 24 patients underwent elective intracranial surgery from January to June, 2009 in "Manuel Ascunce Domenech" Hospital of Camagüey province. In the first patient as maintenance solution we used 0,9% sodium chloride, in the second one 1.1% sodium chloride and in the third we used 1.3% saline solution; in all patients the same neuroanesthesia technique was applied. Variables used included the serum electrolytes determinations of sodium, potassium and chlorine, plasma osmolarity, pH, PaCO2 and standard bicarbonate. Results are expressed in table. Results: Serum osmolarity and restrained electrolytes remained within the normal parameters in most of patients. Respiratory alkalosis present hasn't relation to the use of sodium chloride solutions, but the hyperventilation. Conclusions: With use of the three solutions there weren't significant disturbances of hydroelectrolytic and acid-base equilibrium in most of patients.

Blood loss and transcapillary refill in uncontrolled treated hemorrhage in dogs

Objetive: This study evaluated retroperitoneal hematomas produced by bilateral injury of iliac arteries (uncontrolled hemorrhage), blood volume loss, transcapillary refill, the effects of volume replacement on retroperitoneal bleeding and the hemodynamic changes with and without treatment. Methods: Initial blood volume was determined with Tc99m-labelled red cells, and bleeding was evaluated by means of a portable scintillation camera positioned over the abdomen. Previously splenectomized mongrel dogs (16.8 ± 2.2 kg) were submitted to hemorrhage for 30 minutes and randomized into three groups: I - no treatment (n=7); II - treatment with 32 mL/kg of Lactated Ringer's for three to five minutes (n=7); and III - treatment with 4 mL/kg of 7.5 percent NaCl plus 6.0 percent dextran 70 for three to five minutes (n=7). They were studied for an additional 45 minutes. Results: Volume replacement produced transitory recovery in hemodynamic variables, including mean pulmonary artery pressure, pulmonary capillary wedge pressure and cardiac index, with significant increase in dogs treated with 32 mL/kg of Lactated Ringer's and 7.5 percent NaCl plus 6.0 percent dextran 70 (p<0.001, against no treatment), along with a decrease (p<0.001) in the systemic vascular resistance index. Groups II and III had significant initial decreases in hematocrit and hemoglobin. The treated dogs (groups II and III) presented rebleeding, which was greater during treatment with 32 mL/kg of Lactated Ringer's (group II). Conclusions: Despite the rebleeding observed in treated groups, the utilization of hypertonic saline solution with dextran proved to be effective in the initial reanimation, producing evident transcapillary refill, while the Lactated Ringer's solution produced capillary extravasation and was ineffective in the initial volume replacement in this model of uncontrolled hemorrhage.

The Effect on Acute Lung Injury When 7.5% Hypertonic Saline-Hydroxyethyl Starch for Resuscitated Rats after Hemorrhagic Shock

PURPOSE: Acute lung injury/acute respiratory distress syndrome is common following major trauma, and is one of the most important causes of mortality and morbidity. Compared with gelatine, resuscitation with hydroxyethyl starch (HES) reduces posttrauma capillary leak. Furthermore, hypertonic saline (HTS) is known as a promising fluid resuscitation therapy with the potential to reduce lung injury caused by severe trauma. The aim of this study was to test the hypothesis that resuscitation with mixed fluids, HTS and HES, will reduce inflammation in hemorrhagic shock induced by acute lung injury compared to control (sham injury) or to either fluid alone. METHODS:Spraque-Dawley (SD) rats were divided into five groups randomly: Group I were cannulated but not bled (sham); Group II bled and received Ringer's lactated solution; Group III bled and received 7.5% HTS; Group IV bled and received HES; Group V bled and received a mixeture of HTS and HES (HTS-HES). After anesthetizing the rat, two catheters were inserted into femoral vessels: the femoral artery for monitoring blood pressure and pulse rate; the femoral vein for bleeding and fluid resuscitation. Blood sampling was done for arterial blood gas analysis (ABGA), Tumor necrosis factor-alphaTNF-alpha, Interleukin-6 (IL-6) before shock, after fluid resuscitation and after 48 hours of survival. Bronchoalveolar lavage (BAL) and a lung histology study were conducted in surviving rats. RESULTS: Survival rates were as follows; Group I, 80%; Group II, 100%; Group III, 70%; Group IV, 70%; Group V, 100%. There were no significant between group differences in initial ABGA, hemoglobin, or TNF-alpha TNF-alphaevels postresuscitation were significantly higher in group II compared to groups IV and V. After 48 hours of survival, TNF-alphaas higher in groups IV and V than in group II. After survival, The IL-6 level of group V was significantly lower compared to that of the control group. IL-6 levels in BAL fluid were higher in groups IV and V than in groups I and II. Lung injury histology scores were significantly higher in groups IV and V than in the control group. CONCLUSION: After moderate hemorrhagic shock, lung injury is more severe in rats resuscitated with HTS-HES than in the control groups.

Immunomodulatory Effects of Hypertonic Saline: The Effects on Nuclear Translocation of NF-kappaB and TNF-alpha Synthesis in Stimulated PMNs

PURPOSE: According to current research, hypertonic saline has immunomodulatory effects. NF-kappaB is known as an important transcription factor involved in the production of inflammatory mediators during an inflammatory response. The purpose of this study was to determine the effect of hypertonic saline on both the NF-kappaB signaling pathway and on TNF-alphasynthesis in stimulated PMNs. METHODS: Isolated PMNs from healthy volunteers were subdivided into 3 groups by the incubation conditions: control (not stilmulated, isotonic condition), isotonic (stimulated, isotonic condition), hypertonic (stimulated, hypertonic condition). After nuclear proteins were isolated from the incubated PMNs, NF-kappaB was measured by Western blot. TNF-alpha was measured by ELISA from the culture media. RESULTS: The relative densities of nuclear NF-kappaB after 45 minute incubation were 0.28+/-0.14 (control group), 0.97+/- 0.16 (isotonic group), and 0.58+/-0.07(hypertonic group). Isotonic and hypertonic groups (fMLP stimulated groups) showed a significantly higher relative density than control groups. Among the study groups, the hypertonic groups had a smaller increased level compared to isotonic groups and were found to be statistically significant. The results from the 90 minute incubated groups were similar to that of the 45 minute incubated groups. The concentration of TNF- alphameasured from stimulated groups (isotonic group, hypertonic group) were significantly higher than control groups. Similar to the NF-kappaB result, the concentrations of TNF-alphain the hypertonic groups were significantly lower than isotonic groups. Longer incubation times were noted to display higher concentration in the stimulated groups. CONCLUSION: Stimulated PMNs incubated under hypertonic conditions showed a smaller increase in level of nuclear NF-kappaB and TNF-alphasynthesis compared to isotonic conditions. As a result, suppression of the NF-kappaB signaling pathway in stimulated PMNs is considered one of the mechanisms of hypertonic saline's immunomodulatory effect.

Effects of hypertonic sodium chloride hetastarn on the expression of polymorphonuclear(PMN) Fas following hemorrhagic shock in dogs / 中华急诊医学杂志

Objective To investigate the effects of hypotonic sodium chloride hetastarh 40 injection(HSCH)on the expression of PMN Fas following hemorrhagic shock,and to explore the effective role and mechanisms of HSCH on hemorrhagic shock.Methods Modified Wiggers canine hemorrhagic shock model was used.Expression of Fas in PMN was measured by flow cytometry.Results The levels of PMN Fas expression during hemorrhagic shock were significantly lower than those in control group(P

The Efficacy of Nebulized 3 Percent Hypertonic Saline Solution and Fenoterol in Infants with Bronchiolitis / 소아과

PURPOSE: To evaluate the effect of inhaled hypertonic saline solution in hospitalized infants with bronchiolitis. METHODS: A randomized double blind trial was performed from October 2003 to May 2004. A total of eighty patients <1 year of age with a clinical diagnosis of acute viral bronchiolitis were enrolled and assigned to receive either of the following:inhalation of 2 mL(0.5 mg) fenoterol added to 2 mL of 0.9 percent saline solution(group 1; n=40) or 2 mL(0.5 mg) fenoterol added to 2 mL of 3 percent saline solution(group 2; n=40). This therapy was repeated at six hours interval after admission. They were evaluated daily just before and 20 minutes after nebulization. The outcome measures included changes in clinical severity score(based on respiratory rate, presence of wheezing, retraction, and general condition) after nebulization and duration of hospitalization. RESULTS: In the clinical severity score, a significant improvement was observed during the 72 hours of hospitalization in both groups(P<0.05). The basic clinical severity scores before inhalation were decreased significantly faster in group 2 as compared to group 1 on each day of treatment(P<0.05). The mean duration of hospital stay was significantly reduced in group 2 than group 1(5.9+/-1.9 days versus 7.4+/-2.0 days, P<0.05). No adverse effects were associated with inhaled therapy. CONCLUSION: These results suggest that a nebulized 3 percent saline solution plus 0.5 mg fenoterol may be more effective than a 0.9 percent saline solution plus 0.5 mg fenoterol in accelerating the clinical recovery of infants with viral bronchiolitis.

Effects of hypertonic saline solution on prostacyclin and endotbelin / 中华麻醉学杂志

The effects of hypertonic saline solution (HS) on prostacyclin (PGI2) and endothelin (ET) were evaluated.30 patients under epidural anesthesia during elective operations were infused with 7.5% HS (n=20) or 5% dextrose (n=10) 4ml/kg before anesthesia.PGI2, ET and hemodynamic indices were measured before and 10, 60 min after infusion.In HS group, the PGI2 increased about 51.4%, ET decreased 49.6% and the aortic compliance increased 37.5%. However.after dextrose infusion, PGI2 increased about 23.7% at 60 min, ET increased but dispersedly, with increased TPR and decreased CO, SV.Systolic pressure were declined over 20% in four out of ten patients.It demonstrated that HS could stimulate the secretion of PGI2 and depress ET. These hormonal changes revealed an important role in the course of decreasing TPR, with improving hemodynamios.