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Hypertonic saline in critical illness - A systematic review.
Carmen Andrea Pfortmueller1, Joerg C Schefold1
1Department of Intensive Care, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 10, 3010 Bern, Switzerland.
Journal of Critical Care
|July 27, 2017
Summary
Hypertonic saline resuscitation in critically ill patients may offer volume expansion with less fluid volume. Sparse evidence suggests potential benefits in selected patients, warranting further clinical studies.
Area of Science:
- Critical Care Medicine
- Nephrology
- Emergency Medicine
Background:
- Fluid management in critically ill patients remains a significant clinical challenge.
- Hypertonic saline was historically used for fluid resuscitation but has seen reduced clinical application.
- Current literature on hypertonic saline's effects in critical care is reviewed.
Purpose of the Study:
- To provide an overview of existing literature on hypertonic saline infusion for fluid resuscitation in critically ill patients.
- To analyze the effects of hypertonic saline compared to other crystalloid solutions.
Main Methods:
- A systematic analysis of clinical trials comparing hypertonic saline with other crystalloid solutions.
- Literature search conducted on MEDLINE and Cochrane Controlled Clinical Trials Register (CENTRAL).
- 25 scientific studies met the inclusion criteria after screening 855 titles and abstracts.
Main Results:
- Hypertonic saline resuscitation leads to volume expansion and reduced total infusion volume, potentially beneficial for edematous patients with intravascular volume depletion.
- Renal effects vary based on prior intravascular volume status.
- Serum osmolality and electrolyte changes induced by hypertonic saline are transient.
- Limited evidence suggests reduced perioperative complications, ICU days, and mortality in selected patients.
Conclusions:
- Hypertonic saline may offer benefits in carefully selected critically ill patients.
- Careful patient selection is crucial when considering hypertonic saline for fluid resuscitation.
- Further clinical studies are needed to assess relevant clinical outcomes.
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