Carmen Andrea Pfortmueller1, Joerg C Schefold2. 1. Department of Intensive Care, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 10, 3010 Bern, Switzerland. Electronic address: carmen.pfortmueller@insel.ch. 2. Department of Intensive Care, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 10, 3010 Bern, Switzerland. Electronic address: joerg.schefold@insel.ch.
Abstract
INTRODUCTION: The optimal approach to fluid management in critically ill patients is highly debated. Fluid resuscitation using hypertonic saline was used in the past for more than thirty years, but has recently disappeared from clinical practice. Here we provide an overview on the currently available literature on effects of hypertonic saline infusion for fluid resuscitation in the critically ill. METHODS: Systematic analysis of reports of clinical trials comparing effects of hypertonic saline as resuscitation fluid to other available crystalloid solutions. A literature search of MEDLINE and the Cochrane Controlled Clinical trials register (CENTRAL) was conducted to identify suitable studies. RESULTS: The applied search strategy produced 2284 potential publications. After eliminating doubles, 855 titles and abstracts were screened and 40 references retrieved for full text analysis. At total of 25 scientific studies meet the prespecified inclusion criteria for this study. CONCLUSION: Fluid resuscitation using hypertonic saline results in volume expansion and less total infusion volume. This may be of interest in oedematous patients with intravascular volume depletion. When such strategies are employed, renal effects may differ markedly according to prior intravascular volume status. Hypertonic saline induced changes in serum osmolality and electrolytes return to baseline within a limited period in time. Sparse evidence indicates that resuscitation with hypertonic saline results in less perioperative complications, ICU days and mortality in selected patients. In conclusion, the use of hypertonic saline may have beneficial features in selected critically ill patients when carefully chosen. Further clinical studies assessing relevant clinical outcomes are warranted.
INTRODUCTION: The optimal approach to fluid management in critically illpatients is highly debated. Fluid resuscitation using hypertonicsaline was used in the past for more than thirty years, but has recently disappeared from clinical practice. Here we provide an overview on the currently available literature on effects of hypertonicsaline infusion for fluid resuscitation in the critically ill. METHODS: Systematic analysis of reports of clinical trials comparing effects of hypertonicsaline as resuscitation fluid to other available crystalloid solutions. A literature search of MEDLINE and the Cochrane Controlled Clinical trials register (CENTRAL) was conducted to identify suitable studies. RESULTS: The applied search strategy produced 2284 potential publications. After eliminating doubles, 855 titles and abstracts were screened and 40 references retrieved for full text analysis. At total of 25 scientific studies meet the prespecified inclusion criteria for this study. CONCLUSION: Fluid resuscitation using hypertonicsaline results in volume expansion and less total infusion volume. This may be of interest in oedematous patients with intravascular volume depletion. When such strategies are employed, renal effects may differ markedly according to prior intravascular volume status. Hypertonicsaline induced changes in serum osmolality and electrolytes return to baseline within a limited period in time. Sparse evidence indicates that resuscitation with hypertonicsaline results in less perioperative complications, ICU days and mortality in selected patients. In conclusion, the use of hypertonicsaline may have beneficial features in selected critically illpatients when carefully chosen. Further clinical studies assessing relevant clinical outcomes are warranted.
Authors: Carmen Andrea Pfortmueller; Dominik Uehlinger; Stephan von Haehling; Joerg Christian Schefold Journal: Intensive Care Med Exp Date: 2018-04-13
Authors: W Anthony Hawkins; Susan E Smith; Andrea Sikora Newsome; John R Carr; Christopher M Bland; Trisha N Branan Journal: J Pharm Pract Date: 2019-06-30
Authors: Bjoern Zante; Hermann Reichenspurner; Mathias Kubik; Stefan Kluge; Joerg C Schefold; Carmen A Pfortmueller Journal: PLoS One Date: 2018-10-05 Impact factor: 3.240