Critical evaluation of hypertonic and hypotonic solutions to resuscitate severely burned children

Caldwell, Fred T.; Bowser, Bonny H.

doi:10.1097/00006534-198004000-00095

Cited by 5 publications

(6 citation statements)

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“…However, these side effects were minimal in intensity and duration. In many clinical studies, good tolerance was reported [3,4,[13][14][15]. Infusions of 7.5 % HS 2400 mmol litre" 1 up to 400 ml have been reported to be safe [4].…”

Section: Discussionmentioning

confidence: 99%

Comparison of Hypertonic Saline (5%), Isotonic Saline and Ringer's Lactate Solutions for Fluid Preloading Before Lumbar Extradural Anaesthesia †

Veroli¹,

Benhamou²

1992

British Journal of Anaesthesia

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We have compared the haemodynamic effects of fluid preloading performed before lumbar extradural anaesthesia with isotonic saline (NS), 5% hypertonic saline (HS) and Ringer's lactate (RL) solutions in 30 ASA I patients undergoing minor orthopaedic surgery, allocated randomly to the three groups. All patients received an equal amount of sodium (2 mmol kg-1). After fluid preloading, lumber extradural anaesthesia was performed (2% lignocaine 6 mg kg-1) and ephedrine was administered in order to maintain mean arterial pressure (MAP) > 80% of its control value. Both volume and duration of fluid preload were significantly less in group HS (160 (SD 25) ml, 8.8 (SD 2.9) min) than in the two other groups (NS: 903 (144) ml, 17.7 (3.3) min; RL: 932 (166) ml, 212 (6.0) min) (P < 0.05). The number of blocked segments and the total amount of ephedrine administered were similar in the three groups. Heart rate increased significantly in all groups immediately after the fluid preload and remained increased until the end of the study (90 min). MAP was not affected by any fluid preload and its maximal decrease after lumbar extradural anaesthesia was similar in all groups. Infusion of 5% HS 2.3 ml kg-1 was tolerated well and produced a significant (P < 0.05) but moderate hypernatraemia lasting 90 min after the end of fluid preloading. We conclude that HS may be useful when rapid fluid preloading is desired, in situations where excess free water administration is not desired.

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Section: Discussionmentioning

confidence: 99%

Comparison of Hypertonic Saline (5%), Isotonic Saline and Ringer's Lactate Solutions for Fluid Preloading Before Lumbar Extradural Anaesthesia †

Veroli¹,

Benhamou²

1992

British Journal of Anaesthesia

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“…The earlier studies and those without controls found that the use of LHS resulted in less fluid volume being required than predicted by various formulae, 92–94 and that LHS was safe 95 . Most comparative trials found that the volume requirement for HS solutions was significantly less than for isotonic fluid, 96–105 but three found no such effect 106–108 …”

Section: Traumatic Brain Injurymentioning

confidence: 97%

Review article: Hypertonic saline use in the emergency department

Banks¹,

Furyk²

2008

Emerg Medicine Australasia

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Hypertonic saline (HS) is being increasingly used for the management of a variety of conditions, most notably raised intracranial pressure. This article reviews the available evidence on HS solutions as they relate to emergency medicine, and develops a set of recommendations for its use. To conclude, HS is recommended as an alternative to mannitol for treating raised intracranial pressure in traumatic brain injury. HS is also recommended for treating severe and symptomatic hyponatremia, and is worth considering for both recalcitrant tricyclic antidepressant toxicity and for cerebral oedema complicating paediatric diabetic ketoacidosis. HS is not recommended for hypovolaemic resuscitation.

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“…Of the seven included reviews, three were of fluid resuscitation for critically ill patients (Kwan et al ., , Bunn et al ., , Perel and Roberts, ), two were of neonatal interventions (one investigating respiratory oxygen levels (Saugstad et al ., ) and one the effect of intubation (Halliday and Sweet, )), one was of intubation for adults or children (Lecky et al ., ) and one was of hypothermia following cardiopulmonary resuscitation (Arrich et al ., ). Six of the 11 quasi‐randomized trials did not report a rationale for using quasi‐randomization (Caldwell and Bowser, , Linder et al ., , Ramji et al ., , Evans et al ., , Gausche et al ., , Rabitsch et al ., ). Three trials stated that quasi‐randomization was used to avoid detrimental delay in care (Bickell et al ., , Ramji et al ., , Bajaj et al ., ); a fourth trial also stated this reason adding a desire to avoid a reduction in the recruitment of the most depressed infants (possibly leading to a non‐representative sample; Saugstad et al ., ).…”

Section: Resultsmentioning

confidence: 99%

Randomization methods in emergency setting trials: a descriptive review

Corbett

Moe‐Byrne

Oddie

et al. 2015

Research Synthesis Methods

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BackgroundQuasi‐randomization might expedite recruitment into trials in emergency care settings but may also introduce selection bias.MethodsWe searched the Cochrane Library and other databases for systematic reviews of interventions in emergency medicine or urgent care settings. We assessed selection bias (baseline imbalances) in prognostic indicators between treatment groups in trials using true randomization versus trials using quasi‐randomization.ResultsSeven reviews contained 16 trials that used true randomization and 11 that used quasi‐randomization. Baseline group imbalance was identified in four trials using true randomization (25%) and in two quasi‐randomized trials (18%). Of the four truly randomized trials with imbalance, three concealed treatment allocation adequately. Clinical heterogeneity and poor reporting limited the assessment of trial recruitment outcomes.ConclusionsWe did not find strong or consistent evidence that quasi‐randomization is associated with selection bias more often than true randomization. High risk of bias judgements for quasi‐randomized emergency studies should therefore not be assumed in systematic reviews. Clinical heterogeneity across trials within reviews, coupled with limited availability of relevant trial accrual data, meant it was not possible to adequately explore the possibility that true randomization might result in slower trial recruitment rates, or the recruitment of less representative populations. © 2015 The Authors. Research Synthesis Methods published by John Wiley & Sons, Ltd.

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Critical evaluation of hypertonic and hypotonic solutions to resuscitate severely burned children

Cited by 5 publications

References 0 publications

Comparison of Hypertonic Saline (5%), Isotonic Saline and Ringer's Lactate Solutions for Fluid Preloading Before Lumbar Extradural Anaesthesia †

Comparison of Hypertonic Saline (5%), Isotonic Saline and Ringer's Lactate Solutions for Fluid Preloading Before Lumbar Extradural Anaesthesia †

Review article: Hypertonic saline use in the emergency department

Randomization methods in emergency setting trials: a descriptive review

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