Treatment of Refractory Hypovolæmic Shock by 7·5% Sodium Chloride Injections

Felippe, J.; Timoner, J; Velasco, Irineu Tadeu; Lopes, Oswaldo Ubrı́aco; Rocha-e-Silva, Maurício

doi:10.1016/s0140-6736(80)92157-1

Cited by 194 publications

(25 citation statements)

References 10 publications

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“…Resuscitation with hypertonic saline after hemorrhage improves survival compared with an equal volume of isotonic NaCl (7,32). As confirmed by the present study, MAP and CO are rapidly restored by hypertonic saline administered in a volume of 10% of shed blood volume (21), which is largely due to a rapid increase in intravascular volume.…”

Section: Discussionsupporting

confidence: 76%

Hypertonic sodium resuscitation after hemorrhage improves hemodynamic function by stimulating cardiac, but not renal, sympathetic nerve activity

Frithiof

Ramchandra

Hood

et al. 2011

American Journal of Physiology-Heart and Circulatory Physiology

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Frithiof R, Ramchandra R, Hood SG, May CN. Hypertonic sodium resuscitation after hemorrhage improves hemodynamic function by stimulating cardiac, but not renal, sympathetic nerve activity. Am J Physiol Heart Circ Physiol 300: H685-H692, 2011. First published December 10, 2010 doi:10.1152/ajpheart.00930.2010.-Small volume hypertonic saline resuscitation can be beneficial for treating hemorrhagic shock, but the mechanism remains poorly defined. We investigated the effects of hemorrhagic resuscitation with hypertonic saline on cardiac (CSNA) and renal sympathetic nerve activity (RSNA) and the resulting cardiovascular consequences. Studies were performed on conscious sheep instrumented with cardiac (n ϭ 7) and renal (n ϭ 6) sympathetic nerve recording electrodes and a pulmonary artery flow probe. Hemorrhage (20 ml/kg over 20 min) caused hypotension and tachycardia followed by bradycardia, reduced cardiac output, and abolition of CSNA and RSNA. Resuscitation with intravenous hypertonic saline (1.2 mol/l at 2 ml/kg) caused rapid, dramatic increases in mean arterial pressure, heart rate, and CSNA, but had no effect on RSNA. In contrast, isotonic saline resuscitation (12 ml/kg) had a much delayed and smaller effect on CSNA, less effect on mean arterial pressure, no effect on heart rate, but stimulated RSNA, although the plasma volume expansion was similar. Intracarotid infusion of hypertonic saline (1 ml/min bilaterally, n ϭ 5) caused similar changes to intravenous administration, indicating a cerebral component to the effects of hypertonic saline. In further experiments, contractility (maximum change in pressure over time), heart rate, and cardiac output increased significantly more with intravenous hypertonic saline (2 ml/kg) than with Gelofusine (6 ml/kg) after hemorrhage; the effects of hypertonic saline were attenuated by the ␤-receptor antagonist propranolol (n ϭ 6). These results demonstrate a novel neural mechanism for the effects of hypertonic saline resuscitation, comprising cerebral stimulation of CSNA by sodium chloride to improve cardiac output by increasing cardiac contractility and rate and inhibition of RSNA. brain; sodium chloride; sheep; conscious; saline; shock SEVERE HEMORRHAGE IS A LEADING cause of death and morbidity (30). Hypertonic saline solutions are frequently used for resuscitation in states of shock, having beneficial cardiovascular effects comprising improved cardiac output (CO), blood pressure, and regional blood flows (32) and leading to prompt restoration of oxygen delivery. Plasma volume expansion, caused by cellular dehydration via an osmotic gradient, partly accounts for these effects. There is, however, evidence that hypertonic saline has important additional actions to increase cardiac function, as similar increases in plasma volume by other fluids cause less improvement in CO (2). Studies investigating the direct effects of elevated osmolality/sodium levels on the heart have rendered inconclusive results, showing increased, decreased, or no effect on cardiac performance (5,10,13,2...

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Section: Discussionsupporting

confidence: 76%

Hypertonic sodium resuscitation after hemorrhage improves hemodynamic function by stimulating cardiac, but not renal, sympathetic nerve activity

Frithiof

Ramchandra

Hood

et al. 2011

American Journal of Physiology-Heart and Circulatory Physiology

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“…In these patients, the shock state was reserved after intravenous injections of 100-400 ml of 7.5% sodium chloride -given 50 ml at a time -by a rise in arterial pressure, improvement of urine flow and recovery of consciousness (15).…”

Section: Concept Of "Small-volume Resuscitation"mentioning

confidence: 99%

Hypertonic volume therapy: feasibility in the prevention and treatment of multiple organ failure and sepsis

Pacheco¹,

Coimbra²,

Kreimeier³

et al. 1995

Sao Paulo Med. J.

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Small-volume resuscitation by means of bolus infusion of hypertonic saline solutions was first applied for the primary treatment of severe hemorrhagic and traumatic shock and promptly restored central hemodynamics and regional organ blood flow. Mechanisms of action are diverse -i. maintenance of high cardiac output (direct myocardial stimulation; increase in intravascular volume); ii.maintenance of peripheral arterial vasodilation (effect of hyperosmolality; plasma volume effect) and iii. reduction of tissue edema (shifting of tissue water along the osmotic gradient). These mechanisms promote the restoration of the severely impaired microcirculation frequently seen also in sepsis. Hypertonic volume therapy has been the object of several experimental studies of acute hyperdynamic endotoxemia, however, a greater number of clinical studies have to be developed for the better understanding of the positive, and perhaps hazardous, effects of small-volume resuscitation in sepsis and multiple organ failure. The aim of this paper is to review the concepts involving such solutions, and their potential use in treatment of profound hypovolemia and microcirculatory deterioration associated with sepsis and endotoxic shock.

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“…6 A preliminary human study by de Felippe et al showed that 7.5% NaCl solutions given in successive 50 ml aliquots to patients in hemorrhagic shock induced beneficial hemodynamic effects. 7 Soon afterwards, in the laboratory of George Kramer, it was shown that the association of dextran to hypertonic saline combined the hyperosmotic effects of NaCl to the hyperoncotic effects of dextran and added new conceptual and practical possibilities. 8,9 This review is a follow-up of our previously published coverage of the subject and endeavors to follow developments over the past eight years.…”

Section: ' Introductionmentioning

confidence: 99%

Hypertonic saline for treatment of shock: have we looked for everything?

Silva

2014

Medical Express

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This review is dedicated to the memory of Luis Poli de Figueiredo, who is responsible for much of what we know about small volume resuscitation. Small volume hypertonic resuscitation was originally based on the concept that a physiologically significant blood volume expansion follows the administration of a comparatively small volume of hypertonic fluid. Because hypertonicity is a physiological vasodilator, its use after severe blood loss induces reperfusion. Previously reported research disclosed a number of additional properties of hypertonic NaCl, amongst them (i) the correction of endothelial and red cell edema with significant consequences in terms of capillary blood flow; (ii) modulation of the immune system, with applications repercussions in the field of sepsis. This review covers developments in this field that occurred from 2005 through 2013. We discuss the discrepancy between animal experiments and human trials, and argue that the basic objective of most multicenter clinical trials may have been based upon a poor strategy.K EYWORDS: Shock; Hemorrhage; Sepsis Hypertonic saline; Immune circulation.Rocha-e-Silva M. Hypertonic saline for treatment of shock: have we looked for everything? MEDICALEXPRESS. 2014;1(1):14-21.

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Treatment of Refractory Hypovolæmic Shock by 7·5% Sodium Chloride Injections

Cited by 194 publications

References 10 publications

Hypertonic sodium resuscitation after hemorrhage improves hemodynamic function by stimulating cardiac, but not renal, sympathetic nerve activity

Hypertonic sodium resuscitation after hemorrhage improves hemodynamic function by stimulating cardiac, but not renal, sympathetic nerve activity

Hypertonic volume therapy: feasibility in the prevention and treatment of multiple organ failure and sepsis

Hypertonic saline for treatment of shock: have we looked for everything?

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