Fluid resuscitation with hypertonic saline in endotoxic shock.

Hypertonic saline has been used in the treatment of hypovolemic or burn shock for its rapid volemic effects. Hypertonic solutions could also improve cardiac performance and protect cellular metabolism in acute circulatory failure. We therefore studied the hemodynamic effects of continuous hypertonic saline infusion in the treatment of severe endotoxic shock in the dog. Thirty minutes after slow injection of 3 mg/kg of Escherichia coli endotoxin, fluid resuscitation with either hypertonic saline containing 1,200 mOsm of NaCl/liter (eight dogs) or normotonic saline solution (eight dogs) was started and titrated to maintain left-sided filling pressures at control level. For the next 210 min, the total amount of fluid administered was 64.5 +/- 7.8 ml/kg in the hypertonic group and 83.6 +/- 10.3 ml/kg in the normotonic group. These differences were not statistically significant. Intravascular pressures were similar in the two groups, but cardiac output, stroke volume, and oxygen consumption were significantly higher in the hypertonic group. These results therefore indicate that hypertonic saline can rapidly restore oxygen transport and tissue oxygen consumption in septic shock. The duration of these hemodynamic effects, however, remains to be determined.