Hypertonic Saline in the Treatment of Hemorrhagic Shock
Abstract
Context: The present review discusses different studies about the treatment of hemorrhagic shock (HS) with hypertonic saline (HTS). Evidence acquisition: We have searched the title in the most popular databases containing recent meta-analysis or randomized clinical trials (RCTs). Results: We introduce the hemodynamic effects and mechanisms of action of HTS in HS. Evidence in this field shows controversial results. There are some data supporting the potential benefits of HTS infusion in HS. The goal of research in this field is to identify the best therapy in HS with the least mortality. Conclusion: Our conclusion shows that although HTS can decrease inflammatory response during HS, it can attenuate hypercoagulability and cause complications. There are no data supporting less mortality while treatment with HTS versus other fluids in HS.
1. Young PP, Cotton BA, Goodnough LT. Massive transfusion protocols for patients with substantial hemorrhage. Transfus Med Rev. 2011;25(4):293-303.
2. Kauvar DS, Lefering R, Wade CE. Impact of hemorrhage on trauma outcome: an overview of epidemiology, clinical presentations, and therapeutic considerations. J Trauma. 2006;60(6 Suppl):S3-11.
3. Paydar S, Kabiri H, Barhaghtalab M, Ghaffarpasand F, Safari S, Baratloo A. Hemodynamic Changes Following Routine Fluid Resuscitation in Patients With Blunt Trauma. Trauma Mon. 2016;21(4):e23682.
4. Bagheri-Hariri S, Yekesadat M, Farahmand S, Arbab M, Sedaghat M, Shahlafar N, et al. The impact of using RUSH protocol for diagnosing the type of unknown shock in the emergency department. Emerg Radiol. 2015;22(5):517-20.
5. Rahim-Taleghani S, Fatemi A, Alavi-Moghaddam M, Shojaee M, Abushouk AI, Forouzanfar MM, et al. Correlation of central venous pressure with venous blood gas analysis parameters; a diagnostic study. Turk J Emerg Med. 2017;17(1):7-11.
6. Jones AE KJ. shock. In: Marx JA, editor. Rosen’s emergency medicine. 1: ELSEVIER; 2014. p. 67-74.
7. Finfer S, Bellomo R, Boyce N, French J, Myburgh J, Norton R, et al. A comparison of albumin and saline for fluid resuscitation in the intensive care unit. N Engl J Med. 2004;350(22):2247-56.
8. Wade CE, Hannon JP, Bossone CA, Hunt MM, Loveday JA, Coppes R, et al. Resuscitation of conscious pigs following hemorrhage: comparative efficacy of small-volume resuscitation. Circ Shock. 1989;29(3):193-204.
9. Maningas PA. Resuscitation with 7.5% NaCl in 6% dextran-70 during hemorrhagic shock in swine: effects on organ blood flow. Crit Care Med. 1987;15(12):1121-6.
10. Traverso LW, Bellamy RF, Hollenbach SJ, Witcher LD. Hypertonic sodium chloride solutions: effect on hemodynamics and survival after hemorrhage in swine. J Trauma. 1987;27(1):32-9.
11. Kobayashi L, Costantini TW, Coimbra R. Hypovolemic shock resuscitation. Surg Clin North Am. 2012;92(6):1403-23.
12. Somand DM WK. Fluid and blood resuscitation in traumatic shock. In: Tintinalli JE, editor. Tintinallis emergency medicine. 1: Mc Grow Hill; 2016. p. 69-74.
13. Nerlich M, Gunther R, Demling RH. Resuscitation from hemorrhagic shock with hypertonic saline or lactated Ringer's (effect on the pulmonary and systemic microcirculations). Circ Shock. 1983;10(2):179-88.
14. Gunnar W, Jonasson O, Merlotti G, Stone J, Barrett J. Head injury and hemorrhagic shock: studies of the blood brain barrier and intracranial pressure after resuscitation with normal saline solution, 3% saline solution, and dextran-40. Surgery. 1988;103(4):398-407.
15. Nakayama S, Sibley L, Gunther RA, Holcroft JW, Kramer GC. Small-volume resuscitation with hypertonic saline (2,400 mOsm/liter) during hemorrhagic shock. Circ Shock. 1984;13(2):149-59.
16. Diebel LN, Tyburski JG, Dulchavsky SA. Effect of hypertonic saline solution and dextran on ventricular blood flow and heart-lung interaction after hemorrhagic shock. Surgery. 1998;124(4):642-9.
17. Corso CO, Okamoto S, Leiderer R, Messmer K. Resuscitation with hypertonic saline dextran reduces endothelial cell swelling and improves hepatic microvascular perfusion and function after hemorrhagic shock. J Surg Res. 1998;80(2):210-20.
18. Angle N, Hoyt DB, Coimbra R, Liu F, Herdon-Remelius C, Loomis W, et al. Hypertonic saline resuscitation diminishes lung injury by suppressing neutrophil activation after hemorrhagic shock. Shock. 1998;9(3):164-70.
19. Coimbra R, Junger WG, Hoyt DB, Liu FC, Loomis WH, Evers MF. Hypertonic saline resuscitation restores hemorrhage-induced immunosuppression by decreasing prostaglandin E2 and interleukin-4 production. J Surg Res. 1996;64(2):203-9.
20. Shi HP, Deitch EA, Da Xu Z, Lu Q, Hauser CJ. Hypertonic saline improves intestinal mucosa barrier function and lung injury after trauma-hemorrhagic shock. Shock. 2002;17(6):496-501.
21. Koike K, Moore FA, Moore EE, Read RA, Carl VS, Banerjee A. Gut ischemia mediates lung injury by a xanthine oxidase-dependent neutrophil mechanism. J Surg Res. 1993;54(5):469-73.
22. Oliveira RP, Velasco I, Soriano FG, Friedman G. Clinical review: Hypertonic saline resuscitation in sepsis. Crit Care. 2002;6(5):418-23.
23. Pascual JL, Ferri LE, Seely AJ, Campisi G, Chaudhury P, Giannias B, et al. Hypertonic saline resuscitation of hemorrhagic shock diminishes neutrophil rolling and adherence to endothelium and reduces in vivo vascular leakage. Ann Surg. 2002;236(5):634-42.
24. van den Elsen MJ, Leenen LP, Kesecioglu J. Hemodynamic support of the trauma patient. Curr Opin Anaesthesiol. 2010;23(2):269-75.
25. Ghafari MH, Moosavizadeh SA, Moharari RS, Khashayar P. Hypertonic saline 5% vs. lactated ringer for resuscitating patients in hemorrhagic shock. Middle East J Anaesthesiol. 2008;19(6):1337-47.
26. Bender R, Breil M, Heister U, Dahmen A, Hoeft A, Krep H, et al. Hypertonic saline during CPR: Feasibility and safety of a new protocol of fluid management during resuscitation. Resuscitation. 2007;72(1):74-81.
27. Sampalis JS, Tamim H, Denis R, Boukas S, Ruest SA, Nikolis A, et al. Ineffectiveness of on-site intravenous lines: is prehospital time the culprit? J Trauma. 1997;43(4):608-15; discussion 15-7.
28. Bahrami S, Zimmermann K, Szelenyi Z, Hamar J, Scheiflinger F, Redl H, et al. Small-volume fluid resuscitation with hypertonic saline prevents inflammation but not mortality in a rat model of hemorrhagic shock. Shock. 2006;25(3):283-9.
29. Krausz MM, Semenikhina L, Hirsh M. Lactated Ringer's solution and hypertonic saline improve survival in uncontrolled hemorrhagic shock in female rats in metestrus. J Surg Res. 2006;132(1):23-31.
30. Mattox KL, Maningas PA, Moore EE, Mateer JR, Marx JA, Aprahamian C, et al. Prehospital hypertonic saline/dextran infusion for post-traumatic hypotension. The U.S.A. Multicenter Trial. Ann Surg. 1991;213(5):482-91.
31. Velasco IT, Pontieri V, Rocha e Silva M, Jr., Lopes OU. Hyperosmotic NaCl and severe hemorrhagic shock. Am J Physiol. 1980;239(5):H664-73.
32. Kreimeier U, Thiel M, Peter K, Messmer K. Small-volume hyperosmolar resuscitation. Acta Anaesthesiol Scand Suppl. 1997;111:302-6.
33. Wade CE, Kramer GC, Grady JJ, Fabian TC, Younes RN. Efficacy of hypertonic 7.5% saline and 6% dextran-70 in treating trauma: a meta-analysis of controlled clinical studies. Surgery. 1997;122(3):609-16.
34. Bulger EM, May S, Kerby JD, Emerson S, Stiell IG, Schreiber MA, et al. Out-of-hospital hypertonic resuscitation after traumatic hypovolemic shock: a randomized, placebo controlled trial. Ann Surg. 2011;253(3):431-41.
35. Wang JW, Li JP, Song YL, Tan K, Wang Y, Li T, et al. Hypertonic saline in the traumatic hypovolemic shock: meta-analysis. J Surg Res. 2014;191(2):448-54.
36. Turner J NJ, Webber L, Cox H, Dixon S, Yates D. A randomized controlled trial of prehospital intravenous fluid replacement therapy in serious trauma. Health Technol Assess 2000;4:1-57.
37. Yaghoubian A, Lewis RJ, Putnam B, De Virgilio C. Reanalysis of prehospital intravenous fluid administration in patients with penetrating truncal injury and field hypotension. Am Surg. 2007;73(10):1027-30.
38. Watters JM, Tieu BH, Differding JA, Muller PJ, Schreiber MA. A single bolus of 3% hypertonic saline with 6% dextran provides optimal initial resuscitation after uncontrolled hemorrhagic shock. J Trauma. 2006;61(1):75-81.
39. Kaweski S, Sise M, Virgilio R. The effect of prehospital fluids on survival in trauma patients. J Trauma. 1990;30(10):1215-8.
40. Saeedi M, HajiseyedJavadi H, Shams-Vahdati S, Eslami V, Mokhtarpour M, Momeni M, et al. Hypertonic saline, normal saline or neither: which is best for uncontrolled hemorrhagic shock? An experimental study in goats. Ulus Travma Acil Cerr Derg 2013;19(6):500-6.
41. Gross D, Landau E, Assalia A, Krausz M. Is hypertonic saline resuscitation safe in “Uncontrolled” hemorrhagic shock? J Trauma. 1988;28(6):751-6.
42. Krausz MM, Landau EH, Klin B, Gross D. Hypertonic saline treatment of uncontrolled hemorrhagic shock at different periods from bleeding. Arch Surg. 1992;127(1):93-6.
2. Kauvar DS, Lefering R, Wade CE. Impact of hemorrhage on trauma outcome: an overview of epidemiology, clinical presentations, and therapeutic considerations. J Trauma. 2006;60(6 Suppl):S3-11.
3. Paydar S, Kabiri H, Barhaghtalab M, Ghaffarpasand F, Safari S, Baratloo A. Hemodynamic Changes Following Routine Fluid Resuscitation in Patients With Blunt Trauma. Trauma Mon. 2016;21(4):e23682.
4. Bagheri-Hariri S, Yekesadat M, Farahmand S, Arbab M, Sedaghat M, Shahlafar N, et al. The impact of using RUSH protocol for diagnosing the type of unknown shock in the emergency department. Emerg Radiol. 2015;22(5):517-20.
5. Rahim-Taleghani S, Fatemi A, Alavi-Moghaddam M, Shojaee M, Abushouk AI, Forouzanfar MM, et al. Correlation of central venous pressure with venous blood gas analysis parameters; a diagnostic study. Turk J Emerg Med. 2017;17(1):7-11.
6. Jones AE KJ. shock. In: Marx JA, editor. Rosen’s emergency medicine. 1: ELSEVIER; 2014. p. 67-74.
7. Finfer S, Bellomo R, Boyce N, French J, Myburgh J, Norton R, et al. A comparison of albumin and saline for fluid resuscitation in the intensive care unit. N Engl J Med. 2004;350(22):2247-56.
8. Wade CE, Hannon JP, Bossone CA, Hunt MM, Loveday JA, Coppes R, et al. Resuscitation of conscious pigs following hemorrhage: comparative efficacy of small-volume resuscitation. Circ Shock. 1989;29(3):193-204.
9. Maningas PA. Resuscitation with 7.5% NaCl in 6% dextran-70 during hemorrhagic shock in swine: effects on organ blood flow. Crit Care Med. 1987;15(12):1121-6.
10. Traverso LW, Bellamy RF, Hollenbach SJ, Witcher LD. Hypertonic sodium chloride solutions: effect on hemodynamics and survival after hemorrhage in swine. J Trauma. 1987;27(1):32-9.
11. Kobayashi L, Costantini TW, Coimbra R. Hypovolemic shock resuscitation. Surg Clin North Am. 2012;92(6):1403-23.
12. Somand DM WK. Fluid and blood resuscitation in traumatic shock. In: Tintinalli JE, editor. Tintinallis emergency medicine. 1: Mc Grow Hill; 2016. p. 69-74.
13. Nerlich M, Gunther R, Demling RH. Resuscitation from hemorrhagic shock with hypertonic saline or lactated Ringer's (effect on the pulmonary and systemic microcirculations). Circ Shock. 1983;10(2):179-88.
14. Gunnar W, Jonasson O, Merlotti G, Stone J, Barrett J. Head injury and hemorrhagic shock: studies of the blood brain barrier and intracranial pressure after resuscitation with normal saline solution, 3% saline solution, and dextran-40. Surgery. 1988;103(4):398-407.
15. Nakayama S, Sibley L, Gunther RA, Holcroft JW, Kramer GC. Small-volume resuscitation with hypertonic saline (2,400 mOsm/liter) during hemorrhagic shock. Circ Shock. 1984;13(2):149-59.
16. Diebel LN, Tyburski JG, Dulchavsky SA. Effect of hypertonic saline solution and dextran on ventricular blood flow and heart-lung interaction after hemorrhagic shock. Surgery. 1998;124(4):642-9.
17. Corso CO, Okamoto S, Leiderer R, Messmer K. Resuscitation with hypertonic saline dextran reduces endothelial cell swelling and improves hepatic microvascular perfusion and function after hemorrhagic shock. J Surg Res. 1998;80(2):210-20.
18. Angle N, Hoyt DB, Coimbra R, Liu F, Herdon-Remelius C, Loomis W, et al. Hypertonic saline resuscitation diminishes lung injury by suppressing neutrophil activation after hemorrhagic shock. Shock. 1998;9(3):164-70.
19. Coimbra R, Junger WG, Hoyt DB, Liu FC, Loomis WH, Evers MF. Hypertonic saline resuscitation restores hemorrhage-induced immunosuppression by decreasing prostaglandin E2 and interleukin-4 production. J Surg Res. 1996;64(2):203-9.
20. Shi HP, Deitch EA, Da Xu Z, Lu Q, Hauser CJ. Hypertonic saline improves intestinal mucosa barrier function and lung injury after trauma-hemorrhagic shock. Shock. 2002;17(6):496-501.
21. Koike K, Moore FA, Moore EE, Read RA, Carl VS, Banerjee A. Gut ischemia mediates lung injury by a xanthine oxidase-dependent neutrophil mechanism. J Surg Res. 1993;54(5):469-73.
22. Oliveira RP, Velasco I, Soriano FG, Friedman G. Clinical review: Hypertonic saline resuscitation in sepsis. Crit Care. 2002;6(5):418-23.
23. Pascual JL, Ferri LE, Seely AJ, Campisi G, Chaudhury P, Giannias B, et al. Hypertonic saline resuscitation of hemorrhagic shock diminishes neutrophil rolling and adherence to endothelium and reduces in vivo vascular leakage. Ann Surg. 2002;236(5):634-42.
24. van den Elsen MJ, Leenen LP, Kesecioglu J. Hemodynamic support of the trauma patient. Curr Opin Anaesthesiol. 2010;23(2):269-75.
25. Ghafari MH, Moosavizadeh SA, Moharari RS, Khashayar P. Hypertonic saline 5% vs. lactated ringer for resuscitating patients in hemorrhagic shock. Middle East J Anaesthesiol. 2008;19(6):1337-47.
26. Bender R, Breil M, Heister U, Dahmen A, Hoeft A, Krep H, et al. Hypertonic saline during CPR: Feasibility and safety of a new protocol of fluid management during resuscitation. Resuscitation. 2007;72(1):74-81.
27. Sampalis JS, Tamim H, Denis R, Boukas S, Ruest SA, Nikolis A, et al. Ineffectiveness of on-site intravenous lines: is prehospital time the culprit? J Trauma. 1997;43(4):608-15; discussion 15-7.
28. Bahrami S, Zimmermann K, Szelenyi Z, Hamar J, Scheiflinger F, Redl H, et al. Small-volume fluid resuscitation with hypertonic saline prevents inflammation but not mortality in a rat model of hemorrhagic shock. Shock. 2006;25(3):283-9.
29. Krausz MM, Semenikhina L, Hirsh M. Lactated Ringer's solution and hypertonic saline improve survival in uncontrolled hemorrhagic shock in female rats in metestrus. J Surg Res. 2006;132(1):23-31.
30. Mattox KL, Maningas PA, Moore EE, Mateer JR, Marx JA, Aprahamian C, et al. Prehospital hypertonic saline/dextran infusion for post-traumatic hypotension. The U.S.A. Multicenter Trial. Ann Surg. 1991;213(5):482-91.
31. Velasco IT, Pontieri V, Rocha e Silva M, Jr., Lopes OU. Hyperosmotic NaCl and severe hemorrhagic shock. Am J Physiol. 1980;239(5):H664-73.
32. Kreimeier U, Thiel M, Peter K, Messmer K. Small-volume hyperosmolar resuscitation. Acta Anaesthesiol Scand Suppl. 1997;111:302-6.
33. Wade CE, Kramer GC, Grady JJ, Fabian TC, Younes RN. Efficacy of hypertonic 7.5% saline and 6% dextran-70 in treating trauma: a meta-analysis of controlled clinical studies. Surgery. 1997;122(3):609-16.
34. Bulger EM, May S, Kerby JD, Emerson S, Stiell IG, Schreiber MA, et al. Out-of-hospital hypertonic resuscitation after traumatic hypovolemic shock: a randomized, placebo controlled trial. Ann Surg. 2011;253(3):431-41.
35. Wang JW, Li JP, Song YL, Tan K, Wang Y, Li T, et al. Hypertonic saline in the traumatic hypovolemic shock: meta-analysis. J Surg Res. 2014;191(2):448-54.
36. Turner J NJ, Webber L, Cox H, Dixon S, Yates D. A randomized controlled trial of prehospital intravenous fluid replacement therapy in serious trauma. Health Technol Assess 2000;4:1-57.
37. Yaghoubian A, Lewis RJ, Putnam B, De Virgilio C. Reanalysis of prehospital intravenous fluid administration in patients with penetrating truncal injury and field hypotension. Am Surg. 2007;73(10):1027-30.
38. Watters JM, Tieu BH, Differding JA, Muller PJ, Schreiber MA. A single bolus of 3% hypertonic saline with 6% dextran provides optimal initial resuscitation after uncontrolled hemorrhagic shock. J Trauma. 2006;61(1):75-81.
39. Kaweski S, Sise M, Virgilio R. The effect of prehospital fluids on survival in trauma patients. J Trauma. 1990;30(10):1215-8.
40. Saeedi M, HajiseyedJavadi H, Shams-Vahdati S, Eslami V, Mokhtarpour M, Momeni M, et al. Hypertonic saline, normal saline or neither: which is best for uncontrolled hemorrhagic shock? An experimental study in goats. Ulus Travma Acil Cerr Derg 2013;19(6):500-6.
41. Gross D, Landau E, Assalia A, Krausz M. Is hypertonic saline resuscitation safe in “Uncontrolled” hemorrhagic shock? J Trauma. 1988;28(6):751-6.
42. Krausz MM, Landau EH, Klin B, Gross D. Hypertonic saline treatment of uncontrolled hemorrhagic shock at different periods from bleeding. Arch Surg. 1992;127(1):93-6.
| Files | ||
| Issue | Vol 1 No 1 (2017): Autumn (November) | |
| Section | Review article | |
| PMCID | PMC6548092 | |
| PMID | 31172060 | |
| Keywords | ||
| Evidence-Based Emergency Medicine Saline Solution, Hypertonic Shock, Hemorrhagic Patient Care Management | ||
| Rights and permissions | |
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This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
How to Cite
1.
Vahidi E, Naderpour Z, Saeedi M. Hypertonic Saline in the Treatment of Hemorrhagic Shock. Front Emerg Med. 2017;1(1):e8.
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