Efficacy and safety of hypertonic saline solutions fluid resuscitation on hypovolemic shock: A systematic review and meta-analysis of randomized controlled trials

Abstract

Background: Fluid resuscitation is a fundamental intervention in patients with hypovolemic shock resulting from trauma. Appropriate fluid resuscitation in trauma patients could reduce organ failure, until blood components are available, and hemorrhage is controlled. We conducted a systematic review and meta-analysis assessing the effect of hypertonic saline/dextran or hypertonic saline for fluid resuscitation on patient outcomes restricted to adults with hypovolemic shock. Methods: We conducted a search of electronic information sources, including PubMed, Embase, Web of Science, Cochrane library and bibliographic reference lists to identify all randomized controlled trials (RCTs) investigating outcomes of crystalloids versus colloids in patients with hypovolemic shock. We calculated the risk ratio (RR) or mean difference (MD) of groups using fixed or random-effect models. Results: Fifteen studies including 3264 patients met our inclusion criteria. Survival to hospital discharge rate between research groups varied and amounted to 71.2% in hypertonic saline/dextran group vs. 68.4% for isotonic/normotonic fluid (normal saline) solutions (odds ratio [OR] = 1.19; 95% confidence interval [CI] 0.97-1.45; I 2 = 48%; p = 0.09). 28-to 30-days survival rate for hypertonic fluid solutions was 72.8% survivable, while in the case of isotonic fluid (normal saline) -71.4% (OR = 1.13; 95% CI 0.75-1.70; I 2 = 43%; p = 0.56). Conclusions: This systematic review and meta-analysis, which included only evidence from RCTs hypertonic saline/dextran or hypertonic saline compared with isotonic fluid did not result in superior 28-to 30-day survival as well as in survival to hospital discharge. However, patients with hypotension who received resuscitation with hypertonic saline/dextran had less overall mortality as patients who received conventional fluid.

Reviving the Critically Ill: Exploring Effective Fluid Resuscitation Approaches for Diverse Hypovolemic Shock Cases – A Systematic Review and Meta-Analysis

“…However, we noticed that the mortality rate in HSD seems to be lower as opposed to isotonic crystalloid (21.2% vs.24.4%), suggesting that HSD might have a signi cant improvement in mortality in the future with more randomized trials. Contrary to our nding, a previous systematic review comparing HSD to isotonic crystalloids among patients with hypovolemic shock found that HSD was associated with a signi cant reduction in overall mortality (p = 0.01) [31]. The discrepancy between our ndings and this systematic review can be attributed to our analysis having more randomized trials, which mostly did not show the mortality bene t of HSD over isotonic crystalloids.…”

“…Our meta-analysis has shown that even though the mortality rate was lower in hypertonic crystalloid groups (20% vs. 23%), the difference compared to isotonic crystalloids was statistically insigni cant (p = 0.60). This nding is supported by a previous systematic review, which found no signi cant difference among hypovolemic shock patients resuscitated with hypertonic saline or isotonic saline (OR: 0.90; 95% CI: 0.66-1.23; p = 0.51) [31]. Moreover, we found no signi cant difference in the amount of blood products transfused within the rst 24 hours, suggesting that hypertonic crystalloids are as effective as isotonic crystalloids in resuscitating hypovolemic shock patients.…”

Cerium Dioxide–Dextran Nanocomposites in the Development of a Medical Product for Wound Healing: Physical, Chemical and Biomedical Characteristics

“…Currently, there is an active search for optimal ways to create new wound-healing drugs with a better balance of regenerative and antimicrobial effect of a new type that does not cause antibiotic resistance. Great hopes are placed on nanocomposites based on cerium oxide nanoparticles [ 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 ], which is a rare earth metal with variable valence, coated with a polymer shell, dextran [ 50 , 51 , 52 , 53 , 54 ], which is widely used in medicine [ 67 , 68 , 69 ]. This complex seems to be an excellent combination for the development of a medical drug that effectively accelerates wound healing.…”