[Use of hypertonic NaCl solutions in primary volume therapy]

The i.v. bolus infusion of 4 ml/kg b.w. of hypertonic (7.2-7.5%) saline solution represents a new concept for primary resuscitation from traumatic-hemorrhagic shock; it is called "small-volume resuscitation". Experimental studies have demonstrated that for the case of a 50% blood loss the infusion of 7.2-7.5% NaCl in a dose equivalent to 1/10 of the blood loss effectively restores cardiac filling pressures and cardiac output and significantly increases systemic pressure. Simultaneous application of a colloid (6-10% Dextran 60/70; 6-10% HAES 200,000/0.5) prolongs the circulatory effect of the hypertonic solution. Moreover, "small-volume resuscitation" by means of 7.2 NaCl/10% Dextran 60 was shown to completely restore nutritional organ blood flow already within only 5 minutes. The superiority of "small-volume resuscitation" using hypertonic-hyperoncotic solution as compared to conventional volume therapy consists of its effects on the microcirculation. Recent clinical trials have revealed the efficacy, practicability and safety of this new therapeutic concept for primary resuscitation from trauma and shock.