Immunomodulatory effect of hypertonic saline in hemorrhagic shock

Javad Motaharinia,Azadeh Moghaddas,Mojtaba Mojtahedzadeh,Farhad Etezadi

doi:10.1186/s40199-015-0130-9

Javad Motaharinia, Azadeh Moghaddas + Show 2 more

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https://doi.org/10.1186/s40199-015-0130-9

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Abstract

Multiple organ dysfunction syndrome (MODS) and nosocomial infection following trauma-hemorrhage are among the most important causes of mortality in hemorrhagic shock patients. Dysregulation of the immune system plays a central role in MODS and a fluid having an immunomodulatory effect could be advantageous in hemorrhagic shock resuscitation. Hypertonic saline (HS) is widely used as a resuscitation fluid in trauma-hemorrhagic patients. Besides having beneficial effects on the hemodynamic parameters, HS has modulatory effects on various functions of immune cells such as degranulation, adhesion molecules and cytokines expression, as well as reactive oxygen species production. This article reviews clinical evidence for decreased organ failure and mortality in hemorrhagic shock patients resuscitated with HS. Despite promising results in animal models, results from pre-hospital and emergency department administration in human studies did not show improvement in survival, organ failure, or a reduction in nosocomial infection by HS resuscitation. Further post hoc analysis showed some benefit from HS resuscitation for severely-injured patients, those who received more than ten units of blood by transfusion, patients who underwent surgery, and victims of traumatic brain injury. Several reasons are suggested to explain the differences between clinical and animal models.

Highlights

Multiple organ dysfunction syndrome (MODS) and nosocomial infection following trauma-hemorrhage are the most common causes of mortality in hemorrhagic shock patients [1]
Fluid resuscitation is the mainstay of therapy in hemorrhagic shock, reperfusion of ischemic tissues produces additional injury known as ischemia reperfusion injury (IRI) [2]
Hypertonic saline is safe when used as a resuscitation fluid in the early phase of trauma/hemorrhagic shock

Summary

Introduction

Multiple organ dysfunction syndrome (MODS) and nosocomial infection following trauma-hemorrhage are the most common causes of mortality in hemorrhagic shock patients [1]. Fluid resuscitation is the mainstay of therapy in hemorrhagic shock, reperfusion of ischemic tissues produces additional injury known as ischemia reperfusion injury (IRI) [2]. Hypertonic saline (HS) now is widely used as a resuscitation fluid during critical illness because of its beneficial hemodynamic properties, such as rapid expansion of intravascular volume, reduction of endothelial and tissue edema that improves microcirculation, improvement of blood viscosity caused by hemodilution, and increased myocardial contractility [3, 4]. Recent studies showed that some immunomodulatory effects of HS such as inhibition of b2 integrin expression on neutrophil surface and alteration in inflammatory cytokine production mediated via sodium- or chloride-dependent events rather than by its osmolality [16, 20]

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