Hypertonic solution does not decrease mortality from traumatic hemorrhagic shock: a systematic review and Meta-analysis based on randomized control trials / 中华急诊医学杂志

Objective To evaluate systematically whether administration of hypertonic saline transfusion affects clinical outcomes with compared to standard fluid in the early stage of resuscitation for traumatic shock patients.Methods Seven English and Chinese routine biology and medicine databases were searched for randomized controlled trials (RCTs) published from January 2002 to August 2012,and established inclusion and exclusion criteria to evaluate these RCTs.The quality assessment was based on the Cochrane Handbook for Systematic Reviews of Interventions Version 5.0.1 and Jadad' s score scale.RevMan 5.0 statistical software was used for meta-analysis.Results After evaluated 211 related literatures,five RCTs met all the inclusion criteria and were enrolled for meta-analysis.The meta-a nalysis demonstrated that early hypertonic transfusion did not decrease short-term (first 48 hours after admission) mortality (RR =1.04,P =0.74); nor did it decrease later-term (7day to 3month after injury) mortality (RR =0.97,P =0.72).It also did not decrease the total volume of fluid and blood transfusion required during the first day (P =0.38).Similarly,it did not affect the incidents of infections (RR =1.04,P =0.70),the length of stay in ICU (P =0.2) and total length of stay in the hospital.Conclusions Compared to standard fluid,there was no advantage on mortality and hospital infection by using hypertonic supplement transfusion in the early stage of resuscitation for traumatic shock patients.Hypertonic transfusion did not have any significant effect on the volume of total fluid and blood transfusion required the first day,and no trend of reduction for the length of ICU and hospital stay.Further well-designed randomized controlled trials are needed to demonstrate the cost effectiveness of hypertonic transfusion to traumatic shock patients while in ICU.

Damage of Intestinal Mucosal Barrier Caused by Vinegar Enema and Improvement for Hepatic Encephalopathy / 天津医药

Objective To explore the damage of intestinal mucosal barrier caused by vinegar retention enema, and compare the degree of injury in intestinal mucosal barrier between isotonic vinegar and traditional hypertonic vinegar treat-ment. Methods Sixteen adult rabbits were randomly divided into two groups. The solution of vinegar mixed with normal so-dium was given to hypertonic group. Isotonic group was administered with isosmotic solution made of vinegar and double dis-tilled water, with the same volume fraction and pH as hypertonic group. Then two different osmosis solutions were given as enema solution to rabbits under the same condition. Finally, damages of intestinal mucosa were observed by light microscope and transmission electron microscope (TEM) in two groups. Results It was observed that injuries of rectum and distal part of colon were more severe in hypertonic group than those of isotonic group through light microscope. Besides, cell structures were morphologically normal, with in-line microvilli and intact tight junction in isotonic group. In hypertonic group, microvil-li of intestinal cells decreased or disappeared, the cell junction is widened, and cell apoptosis and necrosis were found through TEM. Conclusion Results showed that isotonic vinegar had less damage to mucosa. Consequently, isotonic vinegar can be considered as enema solution for hepatic encephalopathy to avoid damage by osmosis in clinic.

Hypertonic saline solution reduces the inflammatory response in endotoxemic rats

OBJECTIVE: Volume replacement in septic patients improves hemodynamic stability. This effect can reduce the inflammatory response. The objective of this study was to evaluate the effect of 7.5% hypertonic saline solution versus 0.9% normal saline solution for volume replacement during an inflammatory response in endotoxemic rats. METHODS: We measured cytokines (serum and gut), nitrite, and lipid peroxidation (TBARS) as indicators of oxidative stress in the gut. Rats were divided into four groups: control group (C) that did not receive lipopolysaccharide; lipopolysaccharide injection without treatment (LPS); lipopolysaccharide injection with saline treatment (LPS +S); and lipopolysaccharide injection with hypertonic saline treatment (LPS +H). Serum and intestine were collected. Measurements were taken at 1.5, 8, and 24 h after lipopolysaccharide administration. RESULTS: Of the four groups, the LPS +H group had the highest survival rate. Hypertonic saline solution treatment led to lower levels of IL-6, IL-10, nitric oxide, and thiobarbituric acid reactive substances compared to 0.9% normal saline. In addition, hypertonic saline treatment resulted in a lower mortality compared to 0.9% normal saline treatment in endotoxemic rats. Volume replacement reduced levels of inflammatory mediators in the plasma and gut. CONCLUSION: Hypertonic saline treatment reduced mortality and lowered levels of inflammatory mediators in endotoxemic rats. Hypertonic saline also has the advantage of requiring less volume replacement.

Effect of Hypertonic Fluid Resuscitation in Major Burn Injury

PURPOSE: There are some complications such as pulmonary edema, soft tissue swelling, decreased tissue perfusion which is frequently occurred in isotonic fluid resuscitation like Parkland formula. Hypertonic fluid resuscitation has several effects in burn patients. It may reduce soft tissue swelling and induce fluid shift from interstitium to vascular system. This study aims to compare actual fluid demand after hypertonic fluid resuscitation (160 mEq Na/L) and calculated volume from Parkland formula in severe burn patients. METHODS: From March 2010 to June 2011, a retrospective study was done. 21 patients were selected who had admitted within 6 hours after injury by various mechanisms. Total body surface area was calculated by Lund-Browder diagram. All subjects were treated by hypertonic fluid (Hartmann's solution +30 mEq NaHCo3, 160 mEq/L of Na+). After first 24 hr of resuscitation, physiologic parameters and total infused fluid volume was calculated. Physiologic parameters were used for assessing the effect of fluid therapy, and total infused fluid volume was compared to theoretical volume in Parkland formula, using dependent t-test. RESULTS: Mean TBSA of subjects was 47+/-5%, and four cases were accompanied by inhalation injury. The actual fluid volume infused was about 3.12 ml/kg/% and base excess was -0.5+/-2.8. Pulmonary edema was identified in 4 cases. CONCLUSION: Using hypertonic fluid (160 mEq Na/L), total fluid volume was reduced about 22% compared to Parkland formula without considerable complications.

Two Cases of Corneal Edema Caused by Distilled Water during Cataract Surgery

PURPOSE: To report two cases of toxic corneal reaction induced by infusion of distilled water into anterior chamber during cataract surgery. CASE SUMMARY: The first case was a 60-year-old female who was inadvertently infused with distilled water for 20 minutes during phacoemulsification in place of balanced salt solution (BSS). The second case was a 70-year-old male who received anterior chamber irrigation with distilled water for approximately 1 minute then and then immediately irrigated with BSS as soon as the mistake was identified. In both cases, topical 1% prednisolone acetate and 5% NaCl solution was immediately administered every hour as well as oral prednisolone at 1 mg/kg for one week after which the dose was slowly tapered. The first case completely returned to normal after 3 months, whereas the second case only requied 1 month to return to pre-surgery conditions. CONCLUSIONS: Patients who were exposed to distilled water within the anterior chamber resulted in corneal endothelial damage and corneal edema proportionate to the amount irrigated. However, The corneal edema gradually healed with treatment and eventually regained translucency without complications, completely.

Efeitos cardiovasculares da anestesia dissociativa na reposição volêmica com colóide e solução hipertônica em cães: avaliação biotelemétrica / Cardiovascular effects of dissociative anesthesia in the volemic expansion with colloid and hypertonic solution in dogs: biotelemetric evaluation

Avaliaram-se os efeitos cardiovasculares por um período de 24 horas, após a administração de solução salina hipertônica (NaCl) 7,5 por cento ou em associação ao hidroxietilamido 130/0,4 (HES), em cães com hipovolemia induzida e tratados com cetamina levógira ou racêmica. Após a indução da hipovolemia, administrou-se NaCl 7,5 por cento (4mL/kg) no grupo hipertônica levógira (GHL) e no grupo hipertônica racêmica (GHR) ou HES 130/0,4 na mesma proporção de sangue retirado, associado a NaCl 7,5 por cento (4mL/kg) no grupo hipertônica colóide levógira (GHCL) e no grupo hipertônica colóide racêmica (GHCR). Após 30 minutos, administrou-se por via intravenosa, cetamina levógira (CL; 5mg/kg) no GHL e GHCL ou cetamina racêmica (CR; 10mg/kg) no GHR e GHCR. A frequência cardíaca (FC) e a pressão arterial sistólica (PAS) foram menores após a hipovolemia e após a CR. A pressão arterial média (PAM) e a pressão arterial diastólica (PAD) foram menores após a hipovolemia e após a administração de CL e CR. Não foram observadas diferenças significativas entre os grupos em relação à FC, PAS, PAM e PAD durante o período de mensuração por biotelemetria desde T210 até T1440. A administração de HES associado ao NaCl 7,5 por cento propiciou restabelecimento imediato da PAM, a administração de NaCl 7,5 por cento não restaurou a PAM em pacientes hipovolêmicos, a administração de CR ou CL produziu efeitos semelhantes e todos os tratamentos mantiveram estáveis as pressões arteriais e a FC por um período de até 24 horas.

The cardiovascular effects were evaluated for a 24-hour period, after the administration of hypertonic solution (NaCl 7.5 percent) or in association with hidroxyethyl starch 130/0.4 (HES) in dogs under induced experimental hypovolemia and treated with racemic ketamine (RK) or S(+) ketamine (SK). After the hypovolemia induction, administration of NaCl 7.5 percent (4mL.kg-1) was performed in two groups named hypertonic S(+) (HSG) and hypertonic racemic (HRG), or NaCl 7.5 percent (4mL.kg-1) in association with HES, in the same ratio of removed blood, in two groups named hypertonic colloid S(+) (HCSG) and hypertonic colloid racemic (HCRG). After 30 minutes, SK (5mg.kg-1) was administered by intravenous injection in HSG and HCSG groups, or RK (10mg.kg-1) in HRG and HCRG groups. The heart rate (HR) and systolic arterial pressure (SAP) were lower after hypovolemia and RK. Mean (MAP) and diastolic arterial pressure (DAP) were reduced after hypovolemia and either SK or RK administration. Significant differences were not observed among the groups to HR, SAP, MAP, and DAP during the biotelemetry mensuration period, from T210 to T1440. HES associated with NaCl 7.5 percent administration propitiated immediate re-establishment of MAP. NaCl 7.5 percent administration did not restore MAP in hypovolemic patients. Either RK or SK administrations produced similar effects and all of the treatments maintained stable blood pressure and heart rate for a 24-hour period.

Avaliação hemodinâmica e metabólica da cetamina e cetamina S(+) após a reposição volêmica com hidroxietilamido 130/0,4 e solução salina hipertônica 7,5 por cento / Hemodynamic and metabolic evaluation of ketamine and S(+) ketamine after volemic expansion with hydroxyethyl starch 130/0.4 and hypertonic saline solution

O objetivo deste estudo foi avaliar os efeitos hemodinâmicos e metabólicos, após a administração de solução salina hipertônica (NaCL) 7,5 por cento ou em associação ao hidroxietilamido (HES), em cães com hipovolemia induzida e tratados com cetamina. Após a indução da hipovolemia, administrou-se NaCl 7,5 por cento (4,0ml kg-1) no grupo hipertônica levógira (GHL) e grupo hipertônica racêmica (GHR) ou HES 130/0,4 na mesma proporção de sangue retirado, associado a NaCl 7,5 por cento (4ml kg-1) no grupo hipertônica colóide levógira (GHCL) e no grupo hipertônica colóide racêmica (GHCR). Após 30 minutos, administrou-se, por via IV, cetamina levógira (CL) (5mg kg-1) no GHL e GHCL ou cetamina racêmica (CR) (10mg kg-1) no GHR e GHCR. Empregou-se a análise de variância de uma única via com repetições múltiplas (ANOVA) e o teste de Student Newman Keuls (P ≤ 0,05). A frequência cardíaca e a pressão arterial sistólica foram menores após a hipovolemia e após a CR. As pressões arteriais média e diastólica foram menores após a hipovolemia e cetamina. A pressão venosa central foi maior após a administração do colóide. Os índices cardíaco e sistólico foram menores após a hipovolemia em todos os grupos e, após a fase de expansão no GHL e GHR. A pressão média da artéria pulmonar foi menor após a hipovolemia em todos os grupos. A pressão de oclusão da artéria pulmonar foi maior após o colóide. O índice do trabalho ventricular esquerdo foi menor após a hipovolemia no GHCL e GHCR. O índice da resistência periférica total foi maior após a hipovolemia e menor após a CL. Observou-se acidose metabólica após a hipovolemia e após a cetamina. Ocorreu acidose respiratória após a cetamina no GHL e GHR. Conclui-se que a administração de NaCl 7,5 por cento associado ao HES 130/0,4 promove o restabelecimento imediato dos parâmetros hemodinâmicos e metabólicos no paciente hipovolêmico; a administração isolada de NaCl 7,5 por cento não é capaz...

The objective of this study was to evaluate the hemodynamics and hemogasometrics effects, after the administration of hypertonic solution (NaCl 7.5 percent) or in association with hidroxyethyl starch 130/0.4 (HES), in dogs with induced experimental hypovolemia and treated with racemic ketamine (RK) or S(+) ketamine (SK). After the hypovolemia induction, administration of NaCl 7.5 percent (4 ml kg-1) was performed in two groups called hypertonic S(+) group (HSG) and hypertonic racemic group (HRG), or NaCl 7.5 percent (4 ml kg-1) in association with HES, in the same ratio of removed blood, in two groups called hypertonic colloid S(+) group (HCSG) and hypertonic colloid racemic group (HCRG). After 30 minutes, it was administered by intravenous injection, SK (5tymg kg-1) in HSG and HCSG groups, or RK (10 mg kg-1) in HRG and HCRG groups. To evaluate the significance of the results, it was used One-way Analysis of variance (ANOVA) for repeated measures and Student Newman Keuls method (P ≤ 0.05). The heart rate and the systolic arterial pressure were reduced after hypovolemia and administration of the RK. Mean and diastolic arterial pressure were reduced after hypovolemia and either SK or RK administration. The central venous pressure was increased after administration of the colloid. The cardiac output, index cardiac, and index systolic were reduced after hypovolemia in all groups and, after phase of expansion in HSG and HRG. The pulmonary arterial occlusion pressure was increased after colloid administration. The left ventricular work index was reduced after hypovolemia in HCSG and HCRG. The systemic vascular resistance index was increased after hypovolemia and decreased after administration of the SK. The CO2 concentration to the end of the expiration increased after administration of ketamine in HCSG and HCRG. Metabolic acidosis was observed after hypovolemia and after administration of ketamine in all...

Operating room use of hypertonic solutions: a clinical review

Hyperosmotic-hyperoncotic solutions have been widely used during prehospital care of trauma patients and have shown positive hemodynamic effects. Recently, there has been a growing interest in intra-operative use of hypertonic solutions. We reviewed 30 clinical studies on the use of hypertonic saline solutions during surgeries, with the majority being cardiac surgeries. Reduced positive fluid balance, increased cardiac index, and decreased systemic vascular resistance were the main beneficial effects of using hypertonic solutions in this population. Well-designed clinical trials are highly needed, particularly in aortic aneurysm repair surgeries, where hypertonic solutions have shown many beneficial effects. Examining the immunomodulatory effects of hypertonic solutions should also be a priority in future studies.

A Comparison of the Cerebral and Hemodynamic Effects of Mannitol and Hypertonic Saline in a Rabbit Model of Brain Injury / 대한마취과학회지

There has recently been an increased interest in the use of hypertonic saline for the fluid resuscitation of trauma victims and to control intracranial hypertension. In this study, the cerebral and hemodynamic effects of a 3.2% hypertonic saline solution were compared with those of either a 0.9% saline or 20% mannitol solution in a rabbit model of brain injury. Forty-five minutes following the creation of a left hemispheric cryogenic brain lesion, equal volumes of hypertonic saline, 0.9% saline, or mannitol were infused over a 5 minute period. Monitored variables over the ensuing 120 minutes included mean arterial pressure, central venous pressure, intracranial pressure, hematocrit and serum osmolality. Upon conclusion of the two hour study period, regional cortical water content was determined by the specific gravity method. There were no significant differences in mean arterial pressure between the three groups at any point during the experiment. Plasma osmolality was signifieantly increased by 10-11 mOsm/kg in the mannitol and hypertonic groups. The infusion of either mannitol or hypertonic saline produced a transient decrease in intracranial pressure lasting approximately 60 minutes, whereas animals in the saline group demonstrated a continual increase in intracranial pressure. The lesioned hemisphere demonstrated a significantly greater water content than the non-lesioned hemisphere. There was no difference in regional cortical water content at any sampling site between the various groups.

A Clinical study of the Intracranial Pressure Measurement by Use of a Fiberoptic Pressure Monitor

Continous monitoring of intracranial pressure can be one of the most inportant physical parameters in assesing patients who have or might develop intracranial hypertension. The authors has measured an intracranial epidural pressure by use of a Fiberoptic pressure monitor on 20 cases among brain damaged patients and evaluated it's effect by an epidural pressure change and Glasgow coma scale change after craniectomy and hypertonic solution infusion. Intracranial pressure was compared with signs of increased ICP on brain computed tomography. Also, complications were evaluated. The results are as follows ; 1) Average intracranial pressure was significantly decreased 48cmH2O during the first day after craniectomy. 2) Average intracranial pressure was significantly decreased 33cmH2O after infusion of 10% glycerol. 3) Improvement of the clinical states after craniectomy was not found in the cases above 20cmH2O in spite of decreasing intracranial pressure. 4) Sixteen of seventeen patients showing signs of increased intracranial pressure on brain computed tomography on admission developed elevated intracranial pressure. 5) The infection and intracranial hemorrhage were not found at the monitoring implement site three weeks after removing the intracranial pressure monitor.