Hyperosmotic sodium salts reverse severe hemorrhagic shock: other solutes do not

Silva, M. Rocha e; Velasco, I. T.; Silva, R. I. Nogueira da; Oliveira, M. A.; Negraes, G. A.

doi:10.1152/ajpheart.1987.253.4.h751

Cited by 50 publications

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“…The use of small volumes of HS solution (7.5% NaCl, 2400 mOsm) in experimental hemorrhagic shock models was described in the early 1980s (12) and proved to be as effective as larger volumes of isotonic solution in restoring hemodynamic parameters, arterial pressure and tissue perfusion (12)(13)(14)(15). It also has the advantages of requiring a shorter infusion time (crucial for treatment of patients with severe bleeding), being easier to stock and displaying fewer volume-related complications (e.g., cardiac pulmonary edema) (16).…”

Section: Discussionmentioning

confidence: 99%

Treatment of hemorrhagic shock with hypertonic saline solution modulates the inflammatory response to live bacteria in lungs

Fernandes

Llimona

Godoy

et al. 2009

Braz J Med Biol Res

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Section: Discussionmentioning

confidence: 99%

Treatment of hemorrhagic shock with hypertonic saline solution modulates the inflammatory response to live bacteria in lungs

Fernandes

Llimona

Godoy

et al. 2009

Braz J Med Biol Res

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“…29,30 Increased contractility also has been reported in several studies. 31,32 Restoration of normal intravascular physiology by HSS is achieved through a potent osmotic gradient across the cell membrane that causes a net shift of fluid from the cell (mainly endothelial and red blood cells) through the interstitium into the intravascular space. 22,30 This solution also decreases the swelling of most cell types including neural cells.…”

Section: Discussionmentioning

confidence: 99%

Hypertonic Saline Solution Increases Cerebral Perfusion Pressure During Clinical Orthotopic Liver Transplantation for Fulminant Hepatic Failure: Preliminary Results

Filho

Machado

Nani

et al. 2006

Clinics

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During orthotopic liver transplantation for fulminant hepatic failure, some patients may develop sudden deterioration of cerebral perfusion and oxygenation, mainly due to increased intracranial pressure and hypotension, which are likely responsible for postoperative neurological morbidity and mortality. In the present study, we hypothesized that the favorable effects of hypertonic saline solution (NaCl 7.5%, 4 mL/kg) infusion on both systemic and cerebral hemodynamics, demonstrated in laboratory and clinical settings of intracranial hypertension and hemorrhagic shock resuscitation, may attenuate the decrease in cerebral perfusion pressure that often occurs during orthotopic liver transplantation for fulminant hepatic failure. METHODS: 10 patients with fulminant hepatic failure in grade IV encephalopathy undergoing orthotopic liver transplantation with intracranial pressure monitoring were included in this study. The effect on cerebral and systemic hemodynamics in 3 patients who received hypertonic saline solution during anhepatic phase (HSS group) was examined, comparing their data with historical controls obtained from surgical procedure recordings in 7 patients (Control group). The maximal intracranial pressure and the corresponding mean arterial pressure values were collected in 4 time periods: (T1) the last 10 min of the dissection phase, (T2) the first 10 minutes at the beginning of anhepatic phase, (T3) at the end of the anhepatic phase, and (T4) the first 5 minutes after graft reperfusion. RESULTS: Immediately after hypertonic saline solution infusion, intracranial pressure decreased 50.4%. During the first 5 min of reperfusion, the intracranial pressure remained stable in the HSS group, and all these patients presented an intracranial pressure lower than 20 mm Hg, while in the Control group, the intracranial pressure increased 46.5% (P < 0.001). The HSS group was the most hemodynamically stable; the mean arterial pressure during the first 5 min of reperfusion increased 21.1% in the HSS group and decreased 11.1% in the Control group (P < 0.001). During the first 5 min of reperfusion, cerebral perfusion pressure increased 28.3% in the HSS group while in the Control group the cerebral perfusion pressure decreased 28.5% (P < 0.001). Serum sodium at the end of the anhepatic phase and 3 hours after reperfusion was significantly higher in the HSS group (153.00 ± 2.66 and 149.00 ± 1.73 mEq/L) than in the Control group (143.71 ± 3.30 and 142.43 ± 1.72 mEq/L), P = 0.003 and P < 0.001 respectively. CONCLUSION: Hypertonic saline solution can be successfully used as an adjunct in the neuroprotective strategy during orthotopic liver transplantation for fulminant hepatic failure, reducing intracranial pressure while restoring arterial blood pressure, promoting sustained increase in the cerebral perfusion pressure.

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“…6,[19][20][21][22] The latter two effects are believed to be directly related to the action of the sodium ion on the cardiovascular system. 23 In addition, data from Halvorsen et al suggest that, to a point, the administration of increasing amounts of sodium is associated with incremental improvement in hemodynamic parameters. 24 Considering these facts, it is not surprising that animals resuscitated with HTS did significantly better since they received significantly greater amounts of sodium.…”

Section: Discussionmentioning

confidence: 99%

Resuscitation of Severe Uncontrolled Hemorrhage 7.5% Sodium Chloride/6% Dextran 70 vs 0.9% Sodium Chloride

Stern¹,

Jwayyed²,

Dronen³

et al. 2000

Academic Emergency Medicine

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Abstract.Objectives: Resuscitation studies of hypertonic saline using controlled and uncontrolled hemorrhage models yield conflicting results with regard to efficacy. These disparate results reflect the use of models and resuscitation regimens that are not comparable between studies. This study evaluated the effects of comparable and clinically relevant resuscitation regimens of 7.5% sodium chloride/6% dextran 70 (HSD) and 0.9% sodium chloride (NS) in a near-fatal uncontrolled hemorrhage model. Methods: Thirty-six swine (14.2 to 21.4 kg) with 4-mm aortic tears were bled to a pulse pressure of 5 mm Hg (40-45 mL/kg). The animals were resuscitated with either NS or HSD administered in volumes that provided equivalent sodium loads at similar rates. Group II (n = 12) was resuscitated with 80 mL/kg of NS at a rate of 4 mL/kg/min. Group III (n = 12) received 9.6 mL/ kg of HSD at a rate of 0.48 mL/kg/min. In both groups, crystalloid resuscitation was followed by shed blood infusion (30 mL/kg) at a rate of 2 mL/kg/min. Group I (controls; n = 12) were not resuscitated. Results: One-hour mortality was significantly greater in group I (92%) as compared with group II (33%) and group III (33%) (Fisher's exact test; p = 0.004). Intraperitoneal hemorrhage was significantly greater in group II (34 Ϯ 20 mL/kg) and group III (31 Ϯ 13 mL/ kg) as compared with group I (5 Ϯ 2 mL/kg) (ANOVA; p < 0.05). There was no significant difference in hemodynamic parameters between groups II and III. Conclusion: In this model of severe uncontrolled hemorrhage, resuscitation with HSD or NS, administered in volumes that provided equivalent sodium loads at similar rates, had similar effects on mortality, hemodynamic parameters, and hemorrhage from the injury site. Key words: uncontrolled hemorrhage; shock; resuscitation; hypertonic saline; hemorrhage models; pig. ACADEMIC EMERGENCY MEDICINE 2000; 7:847-856 S TANDARD management of acute life-threatening hemorrhagic hypotension includes attempts to restore blood pressure (BP) to normal or near-normal levels through rapid administration of large volumes of isotonic crystalloid. 1 An alternative resuscitation agent that has shown considerable promise is 7.5% sodium chloride (HTS), used alone or in combination with 6% dextran 70 (HSD). Several animal studies of acute hemorrhagic hypotension have demonstrated that smallvolume infusions of HTS and HSD are more effec- tive in increasing BP, increasing cardiac output, and providing volume expansion as compared with conventional isotonic crystalloids. 2-10 Based on these studies, several authors have advocated the out-of-hospital administration of hypertonic crystalloids for acute hemorrhagic shock. However, not all of the hypertonic saline studies have demonstrated improvement in outcome from resuscitation of acute hemorrhage. More recent studies demonstrate that hypertonic saline resuscitation increases hemorrhage volume and mortality, presumably the result of a rapid rise in BP. [11][12][13][14][15] The authors of the latter studies therefore caution ...

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Hyperosmotic sodium salts reverse severe hemorrhagic shock: other solutes do not

Cited by 50 publications

References 0 publications

Treatment of hemorrhagic shock with hypertonic saline solution modulates the inflammatory response to live bacteria in lungs

Treatment of hemorrhagic shock with hypertonic saline solution modulates the inflammatory response to live bacteria in lungs

Hypertonic Saline Solution Increases Cerebral Perfusion Pressure During Clinical Orthotopic Liver Transplantation for Fulminant Hepatic Failure: Preliminary Results

Resuscitation of Severe Uncontrolled Hemorrhage 7.5% Sodium Chloride/6% Dextran 70 vs 0.9% Sodium Chloride

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