The role of hypertonic saline dextran in trauma resuscitation

Abstract

AM Perera and KM PorterModern trauma management has recognized the importance of using conserva-tive¯uid resuscitation regimes in order to prevent complications from¯uid overload arising. Hypertonic/hyperoncotic¯uids appear to provide an ideal means of facilitating this, requiring only small volumes to rapidly elevate blood pressure. Hypertonic saline dextran (HSD) was introduced in 1985 but its take up has been slow, a large part of this has been due to the lack of human trials and concerns about complications.The current evidence has been reviewed and it is clear that HSD is an ef® cient means of correcting hypotension, doing so mainly by the mobilizing endogenous water. It is becoming apparent that early administration has the potential to modulate the in¯ammatory cascade in patients at risk of developing adult respiratory distress syndrome (ARDS) and multiorgan failure. This is re¯ected in the handful of human trials that show a trend towards increased survival (particularly for head injuries) and a possible reduction in ARDS. The side effect pro® le appears to be good, even in the presence of dehydration or penetrating trauma.Published human trials have methodological problems and lack of power of study this has led to a reliance on animal studies. Clearly there is great potential, but before large-scale prehospital usage can be justi® ed further well-conducted randomized human trials are needed. Downloaded from permeability increase and plasma volume loss induced by endotoxin was attenuated by hypertonic saline with or without dextran. Shock 12(1): 75±80. Diebel LN, Tyburski JG, Dulchavsky SA. 1998. Effect of hypertonic saline solution and dextran on ventricular blood¯ow and heart±lung interaction after hemorrhagic shock. Surgery 124(4): 642±49; discussion 649±50. Doyle JA, Davis DP, Hoyt DB. 2001.The use of hypertonic saline in the treatment of traumatic brain injury. J Trauma 50(2): 367±83. Dubick MA, Summary JJ, Ryan BA, Wade CE. 1989. Dextran concentrationsin plasma and urine following administration of 6% dextran-70= 7.5% NaCl to hemorrhaged and euyolemic conscious swine. Circ Shock 29(4): 301±10. Dubick MA, Zaucha GM, Korte DW Jr, Wade CE. 1993a. Acute and subacute toxicity of 7.5% hypertonic saline-6% dextran-70 (HSD) in dogs. 2. Biochemical and behavioral responses.J Appl Toxicol 13(1): 49±55. Dubick MA, Kilani AF, Summary JJ et al. 1993b. Further evaluation of the effects of 7.5%NaCl= 6% Dextran-70 administration on coagulation and platelet aggregation in haemorrhaged and envolaemic swine. Circ Shock 40: 200±205. Dubick MA, Wade CE. 1994.A review of the ef®cacyand safety of 7.5% NaCl= 6% Dextran 70 in experimental animals and humans. J Trauma 36(3): 323±30. Dubick MA, Davis JM, Myers T, Wade CE, Kramer GC. 1995. Dose response effects of hypertonic saline and dextran on cardiovascular responses and plasma volume expansion in sheep. Shock 3(2): 137±44. Elgjo GI, Mathew BP, Poli Di Figueriedo LF et al. 1998. Resuscitation with HSD improves cardiac function in vivo and ex vivo after burn injury in shee...

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“…Similar symptoms occurred with the infusion of HS-dextran (50). Tissue damage caused by extravasation has been documented and intravenous line patency must be assured before infusion (51).…”

The systemic immune response to trauma: an overview of pathophysiology and treatment

“…dextran and hypertonic saline) 64 have immunomodulatory effects. Here, many lessons can be learned from critically ill patients (Appendix page 7).…”

The more things change, the more they stay the same

“…Perera and Porter 12 reviewed the use of hypertonic saline dextran and its generally positive effects on neutrophil activation and cytokine activity, but concluded that ‘ a well-constructed UK study is needed before large scale usage could be recommended ’ which is of course still awaited.…”