Hypertonic Saline- Hydroxyethyl Starch In Trauma Resuscitation

Thompson, Robert G.; Greaves, Ian

doi:10.1136/jramc-152-01-02

Cited by 15 publications

(11 citation statements)

References 45 publications

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“…In line with previous reports [9,35,39,40], our SR confirmed that the administration of HTS heightened the levels of serum sodium, which was sustained for 6 h, and promoted a temporary reduction of potassium [20-22, 24, 26]. In contrast, mannitol caused a transient acute dilutional hyponatremia [20,22,26], with a concomitant stepwise increase of potassium over time [22].…”

Section: Discussionsupporting

confidence: 92%

“…Hypertonic solutions improve systemic haemodynamics through mechanisms other than changes in serum osmolality, involving myocardial contractility enhancement and capillary systemic vasculature dilatation [33,35].…”

Section: Discussionmentioning

confidence: 99%

“…In contrast, mannitol caused a transient acute dilutional hyponatremia [20,22,26], with a concomitant stepwise increase of potassium over time [22]. However, sodium levels tend to normalize over time, as a result of the diuretic effects of mannitol [28,34,35,41].…”

Section: Discussionmentioning

confidence: 99%

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Cardiac output changes after osmotic therapy in neurosurgical and neurocritical care patients: a systematic review of the clinical literature

Tsaousi

Stazi

Cinicola

et al. 2018

Brit J Clinical Pharma

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AIMOsmotherapy constitutes a first-line intervention for intracranial hypertension management. However, hyperosmolar solutes exert various systematic effects, among which their impact on systemic haemodynamics is poorly clarified. This review aims to appraise the clinical evidence of the effect of mannitol and hypertonic saline (HTS) on cardiac performance in neurosurgical and neurocritical care patients. METHODA database search was conducted to identify randomized clinical trials and observational studies reporting HTS or mannitol use in acute brain injury setting. The primary end-points were alterations of cardiac output (CO) and other haemodynamic variables, while the impact of osmotic agents on intracranial pressure, brain relaxation, plasma osmolality, electrolyte levels and urinary output constituted secondary outcomes. RESULTSEight studies, enrolling 182 patients in total, were included. HTS exerted a more profound cardiac output augmentation than mannitol, but no distinct difference between groups occurred. Central venous pressure, stroke volume and stroke volume variation were favourably affected by both osmotic agents, whilst the reported changes in blood pressure were inconclusive. HTS infusion yielded a larger intracranial pressure reduction than mannitol but had an equivalent effect on brain relaxation. Mannitol presented a more potent diuretic effect than HTS. Effect on serum osmolality was alike in both osmotic agents, but contrary to HTS-promoted hypernatraemia, mannitol use induced transient hyponatraemia. CONCLUSIONSMannitol or HTS administration seems to induce an enhancement of cardiac performance; being more prominent after HTS infusion. This effect combined with mannitol-induced enhancement of diuresis and HTS-promoted increase of plasma sodium concentration could partially explain the effects of osmotherapy on cerebral haemodynamics. British Journal of Clinical Pharmacology WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT• Osmotherapy with either mannitol or hypertonic saline (HTS) is the recommended first-line medical intervention for optimizing cerebral perfusion through brain relaxation.• Mannitol has long been used as osmotic agent for ensuring brain relaxation in neurosurgical patients undergoing craniotomy, but the clinical benefit of mannitol infusion in acute brain injury setting, has not yet been proven according to evidence-based medicine.• Recent guidelines suggest the use of HTS as a second-line therapy in case mannitol fails to reduce intracranial pressure, in patients sustaining traumatic brain injury. WHAT THIS STUDY ADDS• Both mannitol and HTS induce an increase in cardiac output, which is more pronounced after HTS than mannitol administration.• Mannitol and HTS infusion are associated with a trend towards to mean arterial pressure and heart rate reduction.• Both osmotic agents induced an intracranial pressure reduction and brain relaxation, an effect that seems to be more prominent in HTS-treated patients.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

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Cardiac output changes after osmotic therapy in neurosurgical and neurocritical care patients: a systematic review of the clinical literature

Tsaousi

Stazi

Cinicola

et al. 2018

Brit J Clinical Pharma

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“…12,13 Furthermore, a target Hb of 7 to 9 g/dL is recommended. 12,13 Furthermore, a target Hb of 7 to 9 g/dL is recommended.…”

mentioning

confidence: 99%

Microcirculatory Parameters After Isotonic and Hypertonic Colloidal Fluid Resuscitation in Acute Hemorrhagic Shock

Maier

Holz-Hölzl

Pajk

et al. 2009

Journal of Trauma: Injury, Infection &Amp; Critical Care

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Hemorrhaged pigs can be hemodynamically stabilized with either isotonic or hypertonic colloidal fluids. The main finding is an adequate restoration of sublingual microcirculatory blood flow and flow quality in all three study groups, but only gelatin and hydroxyethyl starch improved microvascular hemoglobin oxygen saturation, indicating some inadequate oxygen supply/demand ratio maybe due to a better restoration of systemic hemodynamics in isotonic colloidal resuscitated animals.

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“…However, the resuscitation with continuous HTS infusion had not increased the survival rate compared with that in the NR group. Hypertonic hydroxyethyl starch and HTS were considered to be effective agents for the primary management of traumatic resuscitation both in hospital and prehospital management of injury (17). Recent studies have shown that HTS can prevent circulatory failure in multiple organ dysfunction syndrome (18) and exerts protective effects against inflammation after gut ischemia/reperfusion (19).…”

Section: Discussionmentioning

confidence: 99%