Soluções hipertônicas em pediatria

Abstract

Objective: To describe the current knowledge and indications for use of hypertonic saline solutions in pediatrics patients. Sources of data: Medline recent review articles and personal files. Summary of the findings: Basic physiologic principles were reviewed concerning the distribution of fluid inside the intravascular, interstitial and intracellular compartments. We also reviewed the findings concerning the mechanisms responsible for the rapid onset of cardiocirculatory effects and the additional effect of the colloid component. Finally, we present the medical terms used in the context of small-volume resuscitation, the indications for clinical use, the evidence from clinical research (hemorrhagic shock, preclinical trauma care, septic shock, and head trauma), and the disadvantages and potential adverse effects of small-volume resuscitation. Conclusions: Resuscitation by means of hypertonic saline solutions associated or not with colloid solutions is one of the most innovative concepts for primary resuscitation from trauma and shock established in the past decade. Currently, the spectrum of potential indications involves not only prehospital trauma care, but also perioperative and intensive care therapy. However, additional randomized double-blind studies are required with both children and adult patients to confirm the advantages of the method in terms of survival.

Fluid resuscitation in burned child

“…There is no advantage in administering volumes higher than needed because the edema leads to capillaries compression, ischemia, infection, and deepening of lesions. 3,6,12,13,[16][17][18]…”

“…Although there is no consensus on the adoption of hypertonic rehydration, it is at least as beneficial as isotonic hydration. 5,17,18,21,22 Main indications of hypertonic solutions ■ critical major burn: burns that affect 30% or more of the body surface; ■ delay in the first care: the patient is admitted in shock or evolving to shock. The hypertonic solution allows a quick recovery from the shock and speedy recovery of cardiac and urinary debts; ■ circular burns can tourniquet limbs and compromise blood flow to the extremities, and they can cause difficulty breathing when located on the trunk; ■ extensive lesions of the face and neck leading to the risk of respiratory failure due to edema.…”