7.5% Sodium Chloride/Dextran for Resuscitation of Trauma Patients Undergoing Helicopter Transport

Abstract

To evaluate the use of hypertonic saline/dextran solutions in the prehospital resuscitation of severely injured patients, we administered 250 mL of either 7.5% sodium chloride/dextran 70 (HSD) (n = 83) or lactated Ringer's solution (n = 83), followed by conventional isotonic fluids, to 166 trauma patients with systolic blood pressures less than or equal to 100 mm Hg, in a prospective, randomized, double-blinded clinical trial. Patients in the sodium chloride/dextran 70 group required less fluid before hospitalization and arrived in the emergency department with higher systolic blood pressures than patients in the lactated Ringer's solution group. The rate of survival to hospital discharge for the entire cohort was 64% for patients in the sodium chloride/dextran 70 group vs 59% for patients in the lactated Ringer's solution group. The rate of survival to hospital discharge for the patients with severe head injuries was 32% for the sodium chloride/dextran 70 group vs 16% for the lactated Ringer's solution group. Actuarial survival for patients with severe head injuries in the sodium chloride/dextran 70 group compared with patients with severe head injuries in the lactated Ringer's solution group did not quite reach statistical significance. There were no adverse side effects associated with sodium chloride/dextran 70 administration. Administration of small volumes of sodium chloride/dextran 70 before hospitalization increased the blood pressure of severely injured patients more effectively than did lactated Ringer's solution and showed tendencies toward improving survival in the patients with severe head injuries.

Small Volume Hypertonic Resuscitation of Circulatory Shock

“…A majority of patients received these solutions as the initial treatment for posttraumatic hypotension followed by standard-of-care isotonic crystalloid solutions, both in pre-hospital or in the emergency room environment, including several prospective and doubleblind studies. [70][71][72][73][74][75][76][77][78] These patients have been submitted to extensive clinical and laboratory evaluation, demonstrating the highly desirable safety profile of the tested solutions even when infused to very sick patients such as trauma victims with immediate risk of death from hypovolemia, hemodynamic instability and severe associated lesions. Studies performed in patients undergoing cardiovascular surgeries and in those who are critically ill in intensive care units provide data regarding the effects of hypertonic saline solutions in subjects with associated pre-existing diseases and with limited organ reserve, situations which are seldom seen in young trauma victims.…”

Hypertonic saline in severe traumatic brain injury: a systematic review and meta-analysis of randomized controlled trials

“…11 Recently, hypertonic saline solutions have been suggested as the preferred solution in traumatic brain injury due to their volume repletion properties and their osmotic effect. 6 Hypertonic saline solutions are also considered an alternative in hypotensive trauma patients because of their volume expansion properties, 12 leading to their increased usage, when compared to mannitol, for the management of intracranial pressure. [13][14][15] Six systematic reviews aiming to evaluate the effect of hypertonic saline in neurocritically ill patients have been published showing inconsistent results.…”

Effects of the drogs used as antiedema on the diffus cerebral edema. An experimental study in rats.

“…Vassar ve arkadaşları [27] sistolik kan basıncı 100 mmHg'nin üzerinde olan 166 travmalı olguda %7,5 HTS / %4,2 deksran ile Ringer laktat bolus ve devamında Ringer laktat içeren sıvı infüzyon tedavisini karşılaştırmışlar. Bu çalışmada gruplar arasında Glasgow koma skoru (GCS), Injury Severity Score (ISS), "revised" travma skorları arasında fark bulunamamış-tır.…”