Use Of Hypertonic Saline Solution Research Articles

Perioperative fluid management for adult cardiac surgery: network meta-analysis pooling on twenty randomised controlled trials

BackgroundThe aim of this study was to evaluate colloids and crystalloids used in perioperative fluid therapy for cardiac surgery patients to further investigate the optimal management strategies of different solutions.MethodRCTs about adult surgical patients allocated to receive perioperative fluid therapy for electronic databases, including Ovid MEDLINE, EMBase, and Cochrane Central Register of Controlled Trials, were searched up to February 15, 2023.ResultsNone of the results based on network comparisons, including mortality, transfuse PLA, postoperative chest tube output over the first 24 h following surgery, and length of hospital stay, were statistically significant. Due to the small number of included studies, the results, including acute kidney injury, serum creatinine, serum microglobulin, and blood urea nitrogen, are from the direct comparison. For transfusion of RBCs, significant differences were observed in the comparisons of 3% gelatine vs. 6% HES 200/0.5, 4% albumin vs. 5% albumin, 4% gelatine vs. 5% albumin, 5% albumin vs. 6% HES 200/0.5, and 6% HES 130/0.4 vs. 6% HES 200/0.5. In transfusion of FFP, significant differences were observed in comparisons of 3% gelatine vs. 4% gelatine, 3% gelatine vs. 6% HES 200/0.5, 5% albumin vs. 6% HES 200/0.5, 4% gelatine vs. 5% albumin, 4% gelatine vs. 6% HES 200/0.4, and 6% HES 130/0.4 vs. 6% HES 200/0.5. For urinary output at 24 h after surgery, the results are deposited in the main text.ConclusionThis study showed that 3% gelatin and 5% albumin can reduce the transfuse RBC and FFP. In addition, the use of hypertonic saline solution can increase urine output, and 5% albumin and 6% HES can shorten the length of ICU stay. However, none of the perioperative fluids showed an objective advantage in various outcomes, including mortality, transfuse PLA, postoperative chest tube output over the first 24 h following surgery, and length of hospital stay. The reliable and sufficient evidences on the injury of the kidney, including acute kidney injury, serum creatinine, serum microglobulin, and blood urea nitrogen, was still lacking. In general, perioperative fluids had advantages and disadvantages, and there were no evidences to support the recommendation of the optimal perioperative fluid for cardiac surgery.

Hypertonic saline for goal-directed therapy guided by Capstesia in gastrointestinal surgery: arandomized controlled study.

Goal-directed fluid therapy (GDT) aims to increase stroke volume and cardiac output and improve gut perfusion. Hypertonic saline (HS) can restore the macro-and micro-circulation, increase myocardial contractility, and reduce tissue edema. Therefore, we aimed to investigate the efficacy of intraoperative HS administration in GDT during gastrointestinal (GI) surgery. Forty patients who underwent GI surgery under general anesthesia were enrolled in this randomized controlled study. Patients received boluses of either lactated Ringer's (LR) solution, or 3% HS solution guided by an algorithm dependent on asmartphone application for estimations of pulse pressure variation (PPV). The primary outcome was the total amount of administered intraoperative crystalloid fluids in both groups. Serum sodium and time to first bowel movement after surgery were also recorded. In the HS group, patients received 1262.50 ± 318.25 mL of crystalloids compared to 2667.50 ± 670.29 mL received by patients in the LR group (P 0.05. The use of HS solution for GDT in GI surgery resulted in abeneficial reduction in positive fluid balance and possibly earlier resumption of bowel movements.

Efficacy of Hypertonic Saline Solution to Achieve Persistent Intraoperative Intracranial Hypotension in Endoscopic Endonasal Transsphenoidal Surgery

Abstract. The use of endoscopic transsphenoidal access is an effective and safe method for the surgical treatment of pituitary adenomas (PA). In endoscopic transsphenoidal surgeries, there is a need to control intracranial pressure (ICP) for reposition and expansion of the tumor capsule. Currently, the main method for reducing ICP in transsphenoidal surgery is installation of an external lumbar drainage, which is associated with a number of complications.Aim of study. To improve the results of surgical treatment of patients with hypertension using hypertonic saline solution (HSS).Material and methods. The study included 89 patients, who were devided into two groups: Group A — control group (n=25), where the lumbar drainage was installed for invasive intraoperative measurement of the dynamics of ICP parameters at the main stages of the operation (HSS was not administered in these patients); Group B — study group (n=64), where the efficacy of non­invasive regulation of the tumor capsule position using intravenous HSS was assessed, in addition, lumbar drainage was installed in 25 patients of group B, as well as in group A, for invasive measurement of ICP (the dynamics of ICP changes at the main stages of the operation was measured), and the dynamics of changes in the electrolyte composition of the plasma during the first days after the administration of the HSS was monitored as well.Results. In Group B, there was a more significant decrease in ICP in the course of HSS (on average by 22.49 mm Hg) compared to Group A, where the decrease in ICP was 14.23–8,46 mm Hg (from 13.62±1.36 mm Hg, p<0.05). After intravenous administration of HSS, the plasma composition changed as expected (the concentrations of Na+ and Cl­ increased on average to 150±0.71 mmol/L and 118.3±1.06 mmol/L, respectively, which slightly exceeded the average statistical norm, K + slightly decreased within the average statistical norm), during the first day there was a normalization of the above laboratory parameters .This technique was used to obtain patent No. 2669924 “A method for regulating the position of a tumor capsule in endoscopic transsphenoidal surgery of pituitary adenoma”.Conclusion. The use of HSS is a safe non­invasive technique for expansion of the tumor capsule during operations to remove pituitary adenomas using transsphenoidal endoscopic access. It should be noted that this method is most appropriate in situations not associated with the risk of developing intraoperative liquorrhea.

40 Use of hypertonic saline solution + hyaluronic acid in patients with cystic fibrosis: a retrospective evaluation

40 Use of hypertonic saline solution + hyaluronic acid in patients with cystic fibrosis: a retrospective evaluation

Shock séptico. Actualización en tratamiento con suero salino hipertónico y hormona antidiurética-vasopresina

Safety in the use of small volumes of hypertonic saline solution for hypovolaemic shock and in the treatment of intracranial hypertension has been demonstrated in studies in the field of resuscitation. There is little experience of this for septic shock in humans. Beneficial immunomodulatory effects have been detected in pre-clinical studies. Interactions with the pituitary-adrenal axis and with the secretion of anti-diuretic hormone are varied and suggestive, but are not sufficiently understood. On the other hand, vasopressin has cardiovascular, osmoregulatory, and coagulation effects, and also acts on the hypothalamic-pituitary-adrenal axis. There is a relative deficit of vasopressin in septic shock. Its use in these patients does seem to have any advantages as regards mortality, but may be beneficial in patients at risk from acute renal failure, or those who receive corticosteroids. Terlipressin is a vasopressin analogue that has also been studied. The synergy between vasopressin and hypertonic saline is a hypothesis that is mainly supported in pre-clinical studies. The use of hypertonic saline solution in septic shock, although promising, is still experimental, and must be restricted to the field of controlled clinical trials.

Solução salina hipertônica para prevenção de insuficiência renal em pacientes com insuficiência cardíaca descompensada e hiponatremia

Hyponatremia and congestive phenomena indicate a bad prognosis in decompensated heart failure. The occurrence of renal failure is associated to an increased death risk. To evaluate the safety and efficacy of the hypertonic saline solution in patients with decompensated heart failure for renal failure prevention. Patients with decompensated heart failure, congestion and hyponatremia participated in the study. In addition to the standard treatment, the patients received hypertonic saline solution and were submitted to clinical as well as laboratory assessment. Nine patients were enrolled in the study. Mean age was 55 + 14.2 years, being 5 male (55.5%) and 4 (44.5%) female patients. All of them presented functional class III-IV of the New York Heart Association (NYHA), and 5 (55.5%) received dobutamine. All of them presented initial creatinine > 1.4 mg/dl. The mean tonicity of the solution was 4.39% + 0.018% (2.5% to 7.5%) and the duration of treatment was 4.9 days + 4.1 days (1-15 days). There were no severe adverse effects; none of the patients presented clinical worsening or neurologic disorders; hypokalemia occurred in 4 cases (44.5%). The comparison of the variables before and after treatment showed a decrease in urea (105 mg/dl + 74.8 mg/dl vs. 88 mg/dl + 79.4 mg/dl; p = 0.03) and increase in the urinary volume (1,183 ml/day vs. 1,778 ml/day; p = 0.03); there was no tendency to creatinine decrease (2.0 mg/dl + 0.8 mg/dl vs. 1.7 mg/dl + 1.0 mg/dl; p = 0.08). Despite the elevation in sodium levels (131 mEq/l + 2.8 mEq/l vs. 134 mEq/l + 4.9 mEq/l) and weight decrease (69.5 kg + 18.6 kg vs. 68.2 kg + 17.1 kg), there was no statistically significant difference. The use of hypertonic saline solution in patients with decompensated heart failure can be a safe therapeutic method and potentially related to clinical improvement and renal failure prevention.

Novel Strategies: Challenge Loop Diuretics and Sodium Management in Heart Failure—Part II

The conflicting results of diuretic treatments in heart failure (HF) and the importance of Na management in the context of the cardiorenal syndrome and neurohormonal activation in HF have suggested novel and counterintuitive strategies, focused primarily on the use of vasopressin antagonists and hypertonic saline solution with high doses of loop diuretics and their neurohormonal interference. The emerging novel therapies involving direct inhibition of vasopressin receptors appear to show promising results. The use of hypertonic saline solution mixed with a high dose of loop diuretics produces, probably by indirect mechanisms, a reduction or inhibition of the activated neurohormonal systems in HF patients. This treatment opens a new window on the role of sodium management in these patients and on the relation between sodium and the kidney's role and function in heart failure. The authors review the current evidence for these therapies and suggest hypothetical bases for their efficacy.

Le sérum salé hypertonique en 2004

The concept of small-volume resuscitation encompasses the rapid infusion of a small dose (250 ml) of 7.2 or 7.5% NaCl–colloid solution. Hypertonic saline solution is effective and safe in expanding plasma volume and enhancing cardiac output. Furthermore, hypertonic saline improves microcirculation and modulates the immunological response. These solutions have been approved and registered in European countries for acute hypovolemia. Large and controlled studies are needed to validate the use of hypertonic saline solution in the management of intracranial hypertension or in septic shock.

Qualitative Evaluation of the Blood-Brain Barrier after the Use of Hypertonic Saline Solution in Young Rats

The blood-brain barrier (BBB) controls the biochemical environment of the brain with variable permeability when comparing adults to children. Based on the knowledge that there is a greater vulnerability in the BBB of young subjects submitted to biochemical variations in the blood and in the brain, an experimental model was designed to study small volume resuscitation. Young Wistar rats were submitted to hemorrhage and resuscitated with 7.5% NaCl solution before undergoing a qualitative evaluation of their BBB. Thirty male rats were anesthetized and divided into four groups: Group 1 – submitted to hemorrhagic shock restored with hypertonic saline solution (HSS); Group 2 – submitted to hemorrhagic shock without volume restoration; Group 3 – receiving only HSS, and Group 4 – control. The data analyzed were: mean arterial blood pressure, base excess, sodium, chloride, urea, blood osmolarity and blood glucose levels. After infusing a 2% Evans blue solution, qualitative analysis of the BBB was carried out. Group 1 presented final mean blood pressure levels equivalent to groups 3 and 4. Group 2 had a significant difference in the final base excess when compared to the other groups. In groups 1 and 3, mean sodium and chloride, as well as serum osmolarity, were more elevated than groups 2 and 4. Macroscopic examination of the brain did not reveal any changes in color, which could be attributed to the opening of the BBB. It was concluded that the 7.5% NaCl solution in this experimental model did not promote qualitative changes in the BBB.

Acute and Chronic Effects of Intravenous Hypertonic Saline Solution and Rehydration Fluid on Plasma Electrolyte Concentrations and Renal Function in Holstein Steers

Intravenous (IV) administration of 7.0-7.5% hypertonic saline solution (HSS) is commonly used in dehydrated dairy cows with endotoxic shock and endotoxemia associated with environmental mastitis. Cows are given an IV empirical dose of one to two liters ofHSS (4-5 ml/kg BW) followed by immediate access to drinking water and supportive therapy (anti-inflammatory drugs, oxytocin and frequent milk-out for mastitis). Intravenous small-volume HSS, in conjunction with voluntary oral water consumption, is purported to totally alleviate dehydration without the need for large-volume IV balanced replacement fluids. Use of HSS as the resuscitation fluid for hypovolemia associated with hemorrhagic shock or with loss of vascular tone, as in sepsis or neurogenic shock, remains controversial. HSS resuscitation may detrimentally affect renal function and survival when used in dehydrated patients. This study was conducted to determine detrimental effects on renal function using HSS as the resuscitation fluid in dehydrated cattle.

Resuscitation of anesthetized endotoxemic pigs by use of hypertonic saline solution containing dextran

SUMMARY We evaluated the biochemical and hemodynamic response to hypertonic saline solution plus dextran in isoflurane-anesthetized pigs infused IV with Escherichia coli endotoxin (5 μg/kg of body weight for 0 to 1 hour + 2 μg/kg for 1 to 4 hours). After 120 minutes of endotoxemia, pigs were treated with a bolus (4 ml/kg over 3 minutes) of either normal saline solution (NSS; 0.9% NaCI), or hypertonic saline solution plus dextran (HSSD; 7.5% NaCI + 6% dextran-70). Administration of HSSD significantly (P < 0.05) increased serum osmolality and concentrations of sodium and chloride for approximately 2 hours during endotoxemia. Plasma total protein concentration decreased significantly (P < 0.05) for 2 hours after treatment with HSSD, indicating hemodilution and increased plasma volume. Although HSSD transiently increased cardiac index (CI) for approximately 15 minutes, this effect was not sustained; however, the endotoxin-induced decrease in CI was ameliorated from 120 to 180 minutes. In pigs of the endotoxin + NSS group from 180 to 240 minutes, CI decreased significantly (P < 0.05), compared with baseline and control values. The endotoxin-induced increases in mean pulmonary arterial pressure and pulmonary vascular resistance were not attenuated by HSSD. At 135 minutes, total peripheral vascular resistance was transiently lower (for approx 15 minutes) in pigs treated with HSSD, compared with control pigs. The endotoxin-induced increase in plasma lactate concentration was not attenuated by HSSD, indicating continued peripheral O2 debt. We conclude that, despite sustained increases in serum osmolality and concentrations of sodium and chloride, HSSD has only transiently beneficial cardiopulmonary effects during endotoxemia in pigs.

Evaluation of hemostatic analytes after use of hypertonic saline solution combined with colloids for resuscitation of dogs with hypovolemia

SUMMARY The effects of hypertonic saline solution (htss) combined with colloids on hemostatic analytes were studied in 15 dogs. The analytes evaluated included platelet counts, one-stage prothrombin time, activated partial thromboplastin time, von Willebrand's factor antigen (vWf:Ag), and buccal mucosa bleeding times. The dogs were anesthetized, and jugular phlebotomy was used to induce hypovolemia (mean arterial blood pressure = 50 mm of Hg). Treatment dogs (n = 12) were resuscitated by infusion (6 ml/kg of body weight) of 1 of 3 solutions: htss combined with 6% dextran 70, 6% hetastarch, or 10% pentastarch. The control dogs (n = 3) were autotransfused. Hemostatic analytes were evaluated prior to induction of hypovolemia (baseline) and then after resuscitation (after 30 minutes of sustained hypovolemia) at 0.25, 0.5, 1, 6 and 24 hours. All treatment dogs responded rapidly and dramatically to resuscitation with hypertonic solutions. Clinically apparent hemostatic defects (epistaxis, petechiae, hematoma were not observed in any dog. All coagulation variables evaluated, with the exception of vWf:Ag, remained within reference ranges over the 24-hour period. The vWf:Ag values were not statistically different than values from control dogs, and actual values were only slightly lower than reference ranges. Significant (P ≤ 0.04) differences were detected for one-stage prothrombin time, but did not exceed reference ranges. The results of this study suggested that small volume htss/colloid solutions do not cause significant alterations in hemostatic analytes and should be considered for initial treatment of hypovolemic or hemorrhagic shock.

Compartment syndrome resulting from intravenous regional anesthesia

Three cases of iatrogenic compartment syndrome of the upper extremity are reported. Each was the result of the use of hypertonic saline solution in the administration of intravenous regional anesthesia. Two patients were left with residual problems after resolution of the compartment syndrome despite early surgical intervention in one of these cases. This mechanism may explain other previously reported occurrences of severe swelling in an extremity after intravenous regional anesthesia.

Hyponatremia due to a villous adenoma of the rectosigmoid

1. 1. A case is presented of a sixty-three year old white man with hyponatremia, secondary to an intussuscepting villous adenoma and associated with an esophageal ulcer, esophagitis and a diaphragmatic hernia. 2. 2. The characteristics and treatment of villous adenomas are reviewed. 3. 3. The state of hyponatremia and its treatment are described. 4. 4. The use of hypertonic saline solution (5 per cent) is credited with the rapid cure of the present case.

Further Observations on the Use of Hypertonic Saline Solution in Acute Intestinal Obstruction.*

Further Observations on the Use of Hypertonic Saline Solution in Acute Intestinal Obstruction.*