Hypertonic saline in the traumatic hypovolemic shock: meta-analysis.

Area of Science:

• Emergency Medicine
• Critical Care
• Trauma Surgery

Background:

• Animal studies suggest hypertonic saline (HS) is superior to isotonic saline for fluid resuscitation in traumatic hypovolemic shock.
• Clinical trial results on HS efficacy remain controversial.
• This meta-analysis aimed to clarify the benefits of HS in patients with traumatic hypovolemic shock.

Purpose of the Study:

• To evaluate the efficacy of hypertonic saline (HS) compared to isotonic saline for fluid resuscitation in patients with traumatic hypovolemic shock.
• To analyze the impact of HS on mortality, blood pressure, fluid requirements, and serum sodium levels.

Main Methods:

• A systematic literature search was conducted on PubMed, EMBASE, and Cochrane Central Register of Controlled Trials up to October 2013.
• Six randomized controlled trials were included in the meta-analysis.
• Data extraction and quality assessment were performed independently by two investigators.

Main Results:

• The pooled risk ratio for mortality at discharge was 0.96 (95% CI, 0.82-1.14), indicating no significant difference.
• A significant increase in systolic blood pressure (mean difference 6.47) and serum sodium (mean difference 7.94) was observed with HS administration.
• Data were insufficient to assess the effect of HS on fluid requirements.

Conclusions:

• This meta-analysis did not find a clinically significant improvement in mortality with hypertonic saline administration.
• Hypertonic saline may be associated with significant increases in blood pressure and serum sodium levels.
• Further research is needed to determine the optimal use of HS in traumatic hypovolemic shock.