[Does prehospital hypertonic infusion therapy improve the survival of trauma patients?]

In cases of hypovolaemic shock and trauma, hypertonic saline (HS) resuscitation is beneficial as it results in rapid and efficient fluid redistribution from interstitial and cellular sources to the intravascular compartment. The ensuing haemodilution and reduction in blood viscosity improves venous return and increases preload, while afterload is simultaneously reduced due to the vasodilatory effects of HS. All these changes promote increased cardiac output and improve haemodynamic stability. HS seems to exert a moderate negative inotropic effect on cardiac function. A fluid replacement regimen based on both hypertonic and hyperoncotic fluid components seems to be the most advantageous approach, due to its better maintenance of haemodynamic stability and better restitution of nutritional blood flow. Experimental findings support the use of the colloid, dextran, in combination with HS, due to its beneficial effects on leucocyte-endothelial cell interactions, and thus on microvascular blood flow. As compared with standard fluid regimens, HS without the colloid, dextran, has not been shown to improve survival rates, whereas HS in combination with dextran may be a superior alternative. In specific categories of trauma patients, (e.g., those with head injuries), HS treatment seems clearly advantageous. Registration of HS solutions is currently under way in several countries.