The Use of Hypertonic Saline in Management of Hemorrhagic Shock

Abstract

Background: The most appropriate solution for volume replacement in hemorrhagic shock is controversial, however, hypertonic saline (HTS) solutions have recently gained widespread acceptance. Aim of the work: to study the use of hypertonic saline with the resuscitation fluids in patients with hemorrhagic shock to evaluate the impact of this solution on the extent of early bacterial translocation and blood pressure. Material and method: Forty patients were involved in this prospective study with class II & III hemorrhagic shock. They were randomized into 2 groups, each of 20 patients. Initial resuscitation in group I was done by using Lactated Ringer's (LR) solution with or without blood according to the patient requirements and in the second group of patients (group II), HTS 7.5% with dose of 4 ml /kg body weight was added to the resuscitation fluids. Regular monitoring of vital signs was done and blood samples were withdrawn 1, 30, and 90 minutes after commencement of the resuscitation and sent for blood culture for both aerobic and anaerobic growths. Results: The mean arterial blood pressure in the group I before resuscitation was found to be about 65mm Hg and the mean was raised to 105 mm Hg after 2 hours of resuscitation with LR ± blood. The mean amount of LR used in this group to resuscitate the patients was found to be 40 ml/kg body weight. In group II, the mean arterial blood pressure was found to be 62 mm Hg and it was efficiently controlled by HTS, LR ± blood and the mean arterial blood pressure 2 hours after commencement of resuscitation was elevated to 124 mm Hg. The mean amount of LR used in this group to resuscitate the patients was found to be 18 ml/kg body weight. The blood cultures were positive in 5% of the patients of group II and in 40% of patients of group I. Escherichia coli were the most commonly isolated organism. Conclusion: hypertonic saline was found to be effective for decreasing the rate of early bacterial translocation to blood and also for more efficient restoring of the mean arterial pressure in patients with hemorrhagic shock.