7.5% sodium chloride/dextran for resuscitation of trauma patients undergoing helicopter transport.

To evaluate the use of hypertonic saline/dextran solutions in the prehospital resuscitation of severely injured patients, we administered 250 mL of either 7.5% sodium chloride/dextran 70 (HSD) (n = 83) or lactated Ringer's solution (n = 83), followed by conventional isotonic fluids, to 166 trauma patients with systolic blood pressures less than or equal to 100 mm Hg, in a prospective, randomized, double-blinded clinical trial. Patients in the sodium chloride/dextran 70 group required less fluid before hospitalization and arrived in the emergency department with higher systolic blood pressures than patients in the lactated Ringer's solution group. The rate of survival to hospital discharge for the entire cohort was 64% for patients in the sodium chloride/dextran 70 group vs 59% for patients in the lactated Ringer's solution group. The rate of survival to hospital discharge for the patients with severe head injuries was 32% for the sodium chloride/dextran 70 group vs 16% for the lactated Ringer's solution group. Actuarial survival for patients with severe head injuries in the sodium chloride/dextran 70 group compared with patients with severe head injuries in the lactated Ringer's solution group did not quite reach statistical significance. There were no adverse side effects associated with sodium chloride/dextran 70 administration. Administration of small volumes of sodium chloride/dextran 70 before hospitalization increased the blood pressure of severely injured patients more effectively than did lactated Ringer's solution and showed tendencies toward improving survival in the patients with severe head injuries.

Use of a 7.5% NaCl/6% Dextran 70 solution in the resuscitation of injured patients in the emergency room.

Animal studies and preliminary field patient trials suggest that hypertonic saline solutions can achieve resuscitation of hypovolemic shock with extremely small volumes. In the study reported here, we evaluated the effects of a hypertonic 7.5% NaCl/6% Dextran 70 (HSD) solution in the resuscitation of patients in the emergency room. Thirty-two patients were randomized into a prospective, randomized, placebo-controlled, double-blinded trial in which 250 ml of either HSD or, as a control, lactated Ringers (LR) was used as the initial fluid for resuscitation of patients with systolic blood pressures of 80 mmHg or less. The test solution was given intravenously, usually through a saphenous vein cut-down, over a period of 2-5 minutes. Conventional isotonic solutions were then given as necessary with an average of 2500 ml of fluid being given over the first 30 minutes of resuscitation. Survival was not improved, and the trial proved to be of most interest with regard to measurement of physiological quantities, which might have been expected to have been substantially abnormal because, in many cases, the measurements were made shortly after the infusion ran in. Very few abnormalities, however, were in fact detected. With the exception of one patient, the highest sodium concentration was 156 mEq/l, the highest chloride concentration was 126 mEq/1, and the highest osmolality was 401 mOsm/kg, and this value was obtained in a patient in the control LR group. Osmolality correlated far better with blood alcohol levels (Spearman's rank correlation coefficient = 0.81) than with any other variable, including sodium and chloride concentrations. The HSD solution was safe to use.(ABSTRACT TRUNCATED AT 250 WORDS)

Perspectives on clinical trials for hypertonic saline/dextran solutions for the treatment of traumatic shock.

Animal studies with hypertonic solutions suggest that they can achieve resuscitation of hypovolemic shock with extremely small volumes. Such small volume resuscitation might be ideal in the field treatment of injured patients. Our studies to date, with 60 patients entered into a prospective, randomized, placebo-controlled, and double-blind clinical trial, suggest that the use of a 7.5% NaCl/Dextran 70 solution increases blood pressures during transport. The solutions have been safe, and we have encountered no adverse side effects from their use. Survival rates to date favor use of the solutions, but we do not have convincing statistical significance yet in that regard.

Perspectives on clinical trials for hypertonic saline/dextran solutions for the treatment of traumatic shock

Animal studies with hypertonic solutins suggest that they can achieve resuscitation of hypovolemic shock with extremely small volumes. Such small volume ressuscitation might be ideal in the field treatment of injured patients. Our studies to date, with 60 patients enterd into a prospective, randomized, placebo-controlled, and double-blind clinical trial, suggest that the use of a 7.5% NaCl/Dextran 70 solution increases blood pressures during transport. The solutions have been safe, and we have encoutered no adverse side effects from their use. Survival rates to date favor use of the solutions, but we do not have convincing statistical significance yet in that regard

Preparation of amniotic membranes for surgical use with antibiotic solutions.

A comparative study was conducted to investigate the effectiveness of antibiotic solutions for disinfecting vaginally delivered amniotic membranes. The microbial flora of eight amniotic membranes was defined and six antibiotic solutions were tested for their effectiveness in eliminating aerobic and anaerobic organisms. A solution containing 600 micrograms lincomycin HCl/ml, 500 micrograms neomycin sulfate/ml, 25 micrograms polymyxin B sulfate/ml, and 25 micrograms amphotericin B sulfate/ml in 0.5N saline was found to be capable of disinfecting amniotic membranes stored at 4 degrees C for 24 hours. This solution is now being used to disinfect surgically used amniotic membranes at our institution.

Clinical use of intravenous phenytoin sodium infusions.

The safety of administering phenytoin sodium by intermittent intravenous infusion was evaluated. Twenty-eight adult patients in a neurosurgical intensive-care unit were studied; most patients had head trauma. Ninety-three doses of phenytoin sodium 300 mg in 0.9% sodium chloride injection 50 ml were administered according to hospital-approved guidelines, which included administration over 30-60 minutes, initiation of infusion within one hour of solution preparation, and use of a 5-microns inline filter. All patients were monitored for adverse reactions and were on continuous ECG monitoring. Analysis of clinical data before and immediately after phenytoin infusions showed no statistically significant change in blood pressure and a small but significant drop in mean heart rate. There were no cases of hypotension, arrhythmias, bradycardia, or phlebitis. Single occurrences of hypertension, nystagmus, and pain at the i.v. site were noted. It is concluded that careful infusion of phenytoin sodium in 0.9% sodium chloride injection is safe. The use of approved written guidelines to govern important factors of preparation and administration are recommended.

Phenytoin sodium solubility in three intravenous solutions.

The solubility of phenytoin sodium injection of two manufacturer's was studied in three intravenous fluids, 0.9% sodium chloride, lactated Ringer's, and four manufacturers 5% dextrose injections. Phenytoin sodium for injection was added to 250 ml of an intravenous fluid to give calculated initial concentrations of 0.40, 0.98, 2.38, and 4.55 mg/ml. The pH of each solution was determined before and after the addition of phenytoin. Visual examination and nephelometric measurements for crystals were performed at various times between 5 and 1440 minutes after mixing. Phenytoin concentration was determined by spectrophotometry at these times; nephelometric measurements were done on unfiltered samples. The concentration of phenytoin declined rapidly in all dextrose solutions but at different rates for each brand. A greater stability was demonstrated when phenytoin was diluted in 0.9% sodium chloride and lactated Ringer's injections. Mean concentrations in excess of 95% of initial concentration were maintained for eight hours in those fluids. The two brands of phenytoin sodium injection did not differ consistently with respect to solubility. Crystals were observed in all dextrose solutions; nephelometric measurements indicated crystals were present in all solutions. The pH of all solutions increased sharply upon addition of phenytoin sodium injection. It is concluded that 0.9% sodium chloride and lactated Ringer's injections are suitable diluents for the intravenous administration of phenytoin. Factors other than pH and cosolvent concentration may affect phenytoin stability in dextrose solutions.