Hypertonic saline-dextran solutions for the prehospital management of traumatic hypotension

Maningas, Peter A; Mattox, Kenneth L.; Pepe, Paul E.; Jones, Robert L.; Feliciano, David V.; Burch, Jon M.

doi:10.1016/0002-9610(89)90654-5

Cited by 133 publications

(51 citation statements)

References 24 publications

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“…A majority of patients received these solutions as the initial treatment for posttraumatic hypotension followed by standard-of-care isotonic crystalloid solutions, both in pre-hospital or in the emergency room environment, including several prospective and doubleblind studies. [70][71][72][73][74][75][76][77][78] These patients have been submitted to extensive clinical and laboratory evaluation, demonstrating the highly desirable safety profile of the tested solutions even when infused to very sick patients such as trauma victims with immediate risk of death from hypovolemia, hemodynamic instability and severe associated lesions. Studies performed in patients undergoing cardiovascular surgeries and in those who are critically ill in intensive care units provide data regarding the effects of hypertonic saline solutions in subjects with associated pre-existing diseases and with limited organ reserve, situations which are seldom seen in young trauma victims.…”

Section: Clinical Experience and Perspectivesmentioning

confidence: 99%

Small Volume Hypertonic Resuscitation of Circulatory Shock

Rocha-e-Silva

Figueiredo

2005

Clinics

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Small volume hypertonic resuscitation is a relatively new conceptual approach to shock therapy. It was originally based on the idea that a relatively large blood volume expansion could be obtained by administering a relatively small volume of fluid, taking advantage of osmosis. It was soon realized that the physiological vasodilator property of hypertonicity was a useful byproduct of small volume resuscitation in that it induced reperfusion of previously ischemic territories, even though such an effect encroached upon the malefic effects of the ischemia-reperfusion process. Subsequent research disclosed a number of previously unsuspected properties of hypertonic resuscitation, amongst them the correction of endothelial and red cell edema with significant consequences in terms of capillary blood flow. A whole set of actions of hypertonicity upon the immune system are being gradually uncovered, but the full implication of these observations with regard to the clinical scenario are still under study. Small volume resuscitation for shock is in current clinical use in some parts of the world, in spite of objections raised concerning its safety under conditions of uncontrolled bleeding. These objections stem mainly from experimental studies, but there are few signs that they may be of real clinical significance. This review attempts to cover the earlier and the more recent developments in this field.

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Section: Clinical Experience and Perspectivesmentioning

confidence: 99%

Small Volume Hypertonic Resuscitation of Circulatory Shock

Rocha-e-Silva

Figueiredo

2005

Clinics

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“…[56][57][58] Electrolyte abnormalities are common, with hypernatremia, along with transient hypokalemia and metabolic acidosis secondary to bicarbonate poor fluid administration. 59 Central pontinemyelinosisthough is a theoretical concern, animal studies as well as clinical studies [60][61] do not show a clear association.Administration of HTS also poses a risk of thrombophlebitis especially with higher concentrations and prolonged infusions.Transient therapy with hyperosmolar fluids, however, does not cause thrombophlebitis, [62][63][64] so emergency administration may not be delayed for central venous access. Like mannitol, it may also cause rebound ICH, but the evidences are also less convincing.…”

Section: Hyperosmolar Therapymentioning

confidence: 99%

Management of intracranial hypertension: Recent advances and future directions

Shrestha

Pradhan

2017

Bangladesh Crit Care J

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Intracranial hypertension is a major cause of morbidity and mortality in critically ill patients. Great deal of research has been done with the goal to improve patient outcome, but the challenges are enormous. From basic managementlike sedation and analgesia, to higher tier therapies, there are mixed evidences, some indicating these interventions to be beneficial and some to be equivocal, but the paucity of high-quality trials limits strong recommendations. This review will try to analyze the extensive literature regarding management of raised intracranial pressure, with particular focus on recent advances and will also try to shed some light on future directions.Bangladesh Crit Care J March 2017; 5(1): 53-62

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“…In MEDLINE analysis on hypertonic solutions in human trauma trials, 11 studies were found and analyzed. [24][25][26][27][28][29][30][31][32][33][34] Either hypertonic saline solution (HS; 7.5% NaCl) or a combination of HS with 6% dextran 70 (HSD) were most often used. All studies used crystalloids as a control group, the colloids were not used as a control group.…”

Section: Hypertonic Solutions and Outcomementioning

confidence: 99%

Hypertonic Solutions May Prevent Multiple Organ Failure in Humans: Myth or Reality?

Boldt

2002

Transfus Alt Transfus Med

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Hypertonic saline-dextran solutions for the prehospital management of traumatic hypotension

Cited by 133 publications

References 24 publications

Small Volume Hypertonic Resuscitation of Circulatory Shock

Small Volume Hypertonic Resuscitation of Circulatory Shock

Management of intracranial hypertension: Recent advances and future directions

Hypertonic Solutions May Prevent Multiple Organ Failure in Humans: Myth or Reality?

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