Hypertonic resuscitation: physiologic mechanisms and recommendations for trauma care

Area of Science:

• Emergency Medicine
• Critical Care Medicine
• Physiology

Background:

• Hypertonic saline solutions (HSS) are evaluated as volume expanders.
• 7.5% NaCl/6% dextran 70 (HSD) is a commonly studied HSS formulation.
• HSD's primary action involves osmotic water shift into the vasculature.

Purpose of the Study:

• To review the efficacy and safety of HSD as a volume expander.
• To explore HSD's mechanisms of action and clinical applications.
• To assess HSD's impact on survival in trauma patients.

Main Methods:

• Review of animal studies and clinical trials evaluating HSD.
• Analysis of HSD's physiological effects, including volume expansion and cardiovascular function.
• Examination of data from perioperative and trauma trials.

Main Results:

• HSD demonstrates a volume expansion efficiency 10 times greater than lactated Ringer's solution.
• HSD induces systemic and pulmonary vasodilation, improving cardiac preload and afterload.
• Studies indicate HSD is safe, reduces volume requirements, and suggests increased survival in trauma, especially head and penetrating injuries.

Conclusions:

• HSD is an effective volume expander with multiple beneficial physiological effects.
• HSD shows promise for resuscitation in hypotensive trauma patients, with recommended infusion rates of 10-20 minutes.
• Further research supports HSD's role in improving outcomes for specific trauma populations.