Use of Hypertonic-Hyperoncotic Fluids for Resuscitation of Trauma Patients

Abstract

Use of hipertonic-h!peroncotic fluids for resuscitation of trauma patients. J Intensive Care ,\led 1992;7189-198. Hypertonic sodium chloride solutions in concentrations ranging from 1.5% to 24% have been studied for use in the resuscitation of burn and hemorrhagic shock victims for many years. In animal studies, in the setting of small volume resuscitation, hypertonic sodium chloride is superior to standard isotonic crystalloid resuscitation for restoration of hemodynamic stability. The combination of hypertonic sodium chloride with a hyperoncotic col. loid solution sustains hemodynamic improvements for an additional hour. Hypertonic-hyperoncotic solutions restore vascular volume primarily by drawing water out of the cell and then seIectively partitioning some of the newly recruited fluid within the plasma space. The hyperosmolar state also augments microcirculatory flow, reduces cerebral edema formation, and perhaps increases myocardial contractility. The ability to increase cardiac output with small volume hypertonic-hyperoncotic resuscitation may solve some of the problems related to fluid resuscitation in the prehospital setting when transport times are prolonged or mass casualties need to be treated. Decreasing the volume of fluid required during resuscitation may also prove beneficial in the setting of craniocerebral trauma where the administration of large volumes of crystalloid can increase intracranial pressure. The largest clinical experiences have been reported with the administration of 4 mVkg of 7.5% sodium chloride combined with 6% dextran 70. These studies have shonn that this solution is safe to administer and effective for reversal of hypotension. Whether or not the ability to reverse hypotension will translate into improved suntval remains undetermined at present and will require larger multiinstitutional trials.From the

Efeitos hemodinâmicos e metabólicos imediatos determinados pelas soluções de cloreto de sódio a 7,5% e de sua associação ao dextran 70 a 6% na reanimação do choque hemorrágico: estudo experimental em cães

“…Prospective, randomized studies evaluated the effects of 7.5% NaCl alone or associated with 6% dextran 70 as the initial treatment of hemorrhagic shock in approximately 1,500 patients admitted to hospitals [13][14][15][16] . They demonstrated that the hypertonic solution associated with dextran was safe and free of toxic side effects.…”

“…Estudos prospectivos com distribuição aleatória avaliaram os efeitos das soluções hipertônicas a 7,5% simples ou combinadas com dextran 70 a 6%, como primeiro tratamento no choque hemorrágico, em cerca de 1.500 pacientes internados em unidades hospitalares [13][14][15][16] . Estes estudos mostraram que a solução hipertônica combinada com dextran eram seguras e livres de efeitos colaterais tóxicos.…”

Hypertonic Saline Dextran – The Fluid Of Choice In The Resuscitation Of Haemorrhagic Shock?

“…Colloid solutions are normally 3-10% macromolecules in an isotonic crystalloid to prevent haemolysis. Most colloid solutions have a colloid osmotic (oncotic) pressure similar to plasma (20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30). A 6% solution of albumin is isooncotic and expands plasma volume by 80% of infused volume; 6% hetastarch is slightly hyperoncotic and 6% dextran 70 is markedly hyperoncotic (60)(61)(62)(63)(64)(65)(66)(67)(68)(69)(70)(71)(72)(73)(74)(75) and expands plasma volume by 20-50% more than the infused volume (2)(3)(4).…”

Small-Volume Resuscitation from Hemorrhagic Shock by Hypertonic Saline Dextran – Conceptional Basis and Historical Background

“…Vassar and Holcroft [35], on the basis of their broad clinical experience in the field of small-volume resuscitation, estimate that administration of 250 ml 7.5% NaCl/ 6% dextran 70 to a 70-kg patient who has suffered a 2-liter blood loss will result in plasma volume expansion of at least 700 ml. To achieve equivalent plasma volume expansion with lactated Ringer's solution, these authors estimate 2.8 liters of solution to be necessary.…”