Hypertonic Saline Dextran – The Fluid Of Choice In The Resuscitation Of Haemorrhagic Shock?

Sapsford, W

doi:10.1136/jramc-149-02-03

Cited by 9 publications

(9 citation statements)

References 57 publications

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“…In the present study, our data showed that there were no significant differences in the hemodynamic parameters between the groups after the infusion of 250 mL of HS-HES or 1,000 mL of HES, which corroborate the above results. Moreover, our results indicated that HS-HES could reduce the intraoperative total fluid input and the volume of Ringer's solution required to maintain the patients undergoing surgery, which was in agreement with the evidence that HS can be used as the fluid for small-volume resuscitation in patients with hypovolemic shock (22). However, in the present study, the majority of the total fluid input reduction was due to the initial fluid load.…”

Section: Discussionsupporting

confidence: 90%

Comparison of 7.2% hypertonic saline - 6% hydroxyethyl starch solution and 6% hydroxyethyl starch solution after the induction of anesthesia in patients undergoing elective neurosurgical procedures

Shao¹,

Wang²,

Wang³

et al. 2013

Clinics

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OBJECTIVE:The ideal solution for fluid management during neurosurgical procedures remains controversial. The aim of this study was to compare the effects of a 7.2% hypertonic saline - 6% hydroxyethyl starch (HS-HES) solution and a 6% hydroxyethyl starch (HES) solution on clinical, hemodynamic and laboratory variables during elective neurosurgical procedures.METHODS:Forty patients scheduled for elective neurosurgical procedures were randomly assigned to the HS-HES group or the HES group. After the induction of anesthesia, patients in the HS-HES group received 250 mL of HS-HES (500 mL/h), whereas the patients in the HES group received 1,000 mL of HES (1000 mL/h). The monitored variables included clinical, hemodynamic and laboratory parameters. Chictr.org: ChiCTR-TRC-12002357RESULTS:The patients who received the HS-HES solution had a significant decrease in the intraoperative total fluid input (p<0.01), the volume of Ringer's solution required (p<0.05), the fluid balance (p<0.01) and their dural tension scores (p<0.05). The total urine output, blood loss, bleeding severity scores, operation duration and hemodynamic variables were similar in both groups (p>0.05). Moreover, compared with the HES group, the HS-HES group had significantly higher plasma concentrations of sodium and chloride, increasing the osmolality (p<0.01).CONCLUSION:Our results suggest that HS-HES reduced the volume of intraoperative fluid required to maintain the patients undergoing surgery and led to a decrease in the intraoperative fluid balance. Moreover, HS-HES improved the dural tension scores and provided satisfactory brain relaxation. Our results indicate that HS-HES may represent a new avenue for volume therapy during elective neurosurgical procedures.

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Section: Discussionsupporting

confidence: 90%

Comparison of 7.2% hypertonic saline - 6% hydroxyethyl starch solution and 6% hydroxyethyl starch solution after the induction of anesthesia in patients undergoing elective neurosurgical procedures

Shao¹,

Wang²,

Wang³

et al. 2013

Clinics

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“…The blood volume expansion from a 4 mL/kg dose of HTS-D in a normal human corresponds to a 48 mL/kg dose of normal saline. 204 Many beneficial effects of HTS on immune function, endothelial cell swelling, and cerebral edema occur also with the HTS-D mixtures. 204 Current recommendations for low-volume resuscitation support the use of HTS-D solution.…”

Section: Allogeneic Blood Productsmentioning

confidence: 99%

“…204 Many beneficial effects of HTS on immune function, endothelial cell swelling, and cerebral edema occur also with the HTS-D mixtures. 204 Current recommendations for low-volume resuscitation support the use of HTS-D solution. When used in human clinical trials of trauma resuscitation, hypovolemic shock, and head trauma, or in the post-surgical setting, HTS-D administration often had benefits over crystalloid alone, without exhibiting any significant side effects.…”

Section: Allogeneic Blood Productsmentioning

confidence: 99%

“…Dogs who receive massive transfusion may also experience prolongation of coagulation times and a decreased platelet count because of hemodilution and consumption 201 . Transfusion of 1 blood volume of pRBCs in humans causes thrombocytopenia, low fibrinogen, and prolonged prothrombin time (PT) 203,204 . In cases of massive transfusion, serum electrolytes as well as serial clotting times should be monitored to determine when supplementation with calcium and/or plasma is indicated.…”

Section: Introductionmentioning

confidence: 99%

“…Small infused volumes of HTS‐D result in significant intravascular volume expansion. The blood volume expansion from a 4 mL/kg dose of HTS‐D in a normal human corresponds to a 48 mL/kg dose of normal saline 204 . Many beneficial effects of HTS on immune function, endothelial cell swelling, and cerebral edema occur also with the HTS‐D mixtures 204 …”

Section: Introductionmentioning

confidence: 99%

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Fluid therapy for the traumatized patient

Driessen

Brainard

2006

J Vet Emergen Crit Care

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Objective: To review the rationale behind and experiences with traditional and newly evolving concepts of fluid therapy in the traumatized patient, and to review conventional and novel fluid preparations for use in trauma resuscitation. Data sources: Human and veterinary clinical and research studies. Human data synthesis: Current treatment guidelines recommend aggressive fluid resuscitation with lactated ringers solution (LRS) or saline as optimum management of hemorrhagic shock in trauma, regardless of whether bleeding is controlled or not. The rationale behind this strategy is to restore intravascular volume as rapidly as possible to ensure adequate vital organ perfusion. Recently, this strategy has been challenged, especially in patients with uncontrolled hemorrhage, as neither laboratory evidence nor clinical trials support this practice. Current research indicates that vigorous fluid infusion may exacerbate bleeding and cause severe hemodilution, both impairing resuscitation outcome. As a result, a new line of thinking is emerging that balances the risks and benefits of intravenous volume infusion by offering the clinician alternative treatment strategies and emphasizes continuous endpoint‐oriented monitoring. ‘Hypotensive’ or ‘hypovolemic’ resuscitation techniques as well as initial volume replacement with fluids other than LRS or saline (e.g., hypertonic saline [HTS], HTS with dextran 70 [HTS‐D]) have been introduced in human medical practice as additional options for treatment of victims of trauma under certain circumstances. Clinical studies evaluating the use of hemoglobin‐based oxygen carriers (HBOCs) in the trauma setting are underway and may soon lead to an expansion of the fluid arsenal available to the clinician for treatment of trauma patients. Veterinary data synthesis: Based on available animal data, neither strict guidelines nor a clear fluid preference for resuscitation of traumatic shock have been defined. Although systematic clinical trials are missing, combinations of crystalloid and colloid (natural or artificial) appear to be as effective for resuscitation as crystalloid alone. Judicious use of an HBOC (e.g., Oxyglobin®) as a substitute for blood/red blood cells may be recommended in situations where whole blood or pRBCs are not or not yet available. Conclusions: The search for optimal methods of fluid resuscitation in trauma is ongoing. At this point the best solution is a differentiated approach to fluid therapy, one that tailors type and volume of resuscitation solution(s) used to the type and severity of injury in an individual patient and uses monitoring of perfusion and oxygenation parameters to guide resuscitation. Crystalloid fluids are effective for resuscitation but may need to be combined with or replaced by colloidal fluids in certain clinical situations.

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Intraoperative Infusion of Dextran Confers No Additional Benefit after Carotid Endarterectomy but Is Associated with Increased Perioperative Major Adverse Cardiac Events

Moore¹,

Garg²,

Laskowski³

et al. 2023

Annals of Vascular Surgery

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Hypertonic Saline Dextran – The Fluid Of Choice In The Resuscitation Of Haemorrhagic Shock?

Cited by 9 publications

References 57 publications

Comparison of 7.2% hypertonic saline - 6% hydroxyethyl starch solution and 6% hydroxyethyl starch solution after the induction of anesthesia in patients undergoing elective neurosurgical procedures

Comparison of 7.2% hypertonic saline - 6% hydroxyethyl starch solution and 6% hydroxyethyl starch solution after the induction of anesthesia in patients undergoing elective neurosurgical procedures

Fluid therapy for the traumatized patient

Intraoperative Infusion of Dextran Confers No Additional Benefit after Carotid Endarterectomy but Is Associated with Increased Perioperative Major Adverse Cardiac Events

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