Hypertonic saline resuscitation prevents hydrostatically induced intestinal edema and ileus

The aim of this study was to explore the impact of 3% hypertonic saline (HS) intragastric administration for patients who underwent upper gastrointestinal surgery.During the postoperative period, 3% HS has been suggested as a means to improve the intestinal edema and reduce gastrointestinal complications.The medical records of 111 patients with HS intragastric administration following upper gastrointestinal surgery and 268 patients, served as control, were reviewed retrospectively. Propensity score matching was performed to adjust for selected baseline variables. Clinical outcomes, including early gastrointestinal function recovery, postoperative complications, and length of hospital stay, were compared according to the HS intragastric administration or not.HS intragastric administration was associated with prompt postoperative gastrointestinal function recovery, including first flatus (risk ratio [RR], 1.32; 95% confidence interval [CI], 0.89–1.65; P = 0.048) and feeding within 3 postoperative days (RR (95% CI), 0.57 (0.49–0.77); P = 0.036). Early ileus occurred in 25 of 108 patients with HS treatment versus 36 of 108 patients without HS treatment (RR (95% CI), 1.43 (0.63–2.15); P = 0.065). The patients with HS experienced a lower overall postoperative complication (odds ratio [OD] 0.57; 95% CI, 0.33–1.09; P = 0.063), including trend toward a decrease for infectious complications (15[13.9] vs 23[21.3]; P = 0.11; OD, 0.59; 95% CI, 0.29–1.22). There was a decreased incidence of anastomotic leakage (1[0.9] vs 7[6.5]; P = 0.033) and postoperative ileuas (5[4.6%] vs 11[10.2%]; P = 0.096) in the HS administration patients.Our study demonstrated beneficial postoperative clinical effects of HS intragastric administration in patients who had undergone upper gastrointestinal surgery, such as prompt postoperative gastrointestinal function recovery and reduced overall postoperative complications, which may be attributed to a reduced intestinal edema.

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“…Intestinal edema is related to early ileus, which could postpone the initiation of enteral feeding. [6,7] …”

Section: Introductionmentioning

confidence: 99%

Impact of hypertonic saline on postoperative complications for patients undergoing upper gastrointestinal surgery

et al. 2017

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“…Additionally, administration of hypertonic saline (shown previously to decrease edema and reverse contractile dysfunction) prevented the early and late mechanical changes induced by edema and decreased NHE expression. 5, 8, 9…”

Section: Introductionmentioning

confidence: 99%

Hydrostatic intestinal edema induced signaling pathways: Potential role of mechanical forces

Shah¹,

Fogle²,

Aroom³

et al. 2010

Surgery

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Background-Hydrostatic intestinal edema initiates a signal transduction cascade that results in smooth muscle contractile dysfunction. Given the rapid and concurrent alterations in the mechanical properties of edematous intestine observed with the development of edema, we hypothesize that mechanical forces may serves as a stimulus for activation of certain signaling cascades. We sought to examine if isolated similar magnitude mechanical forces induced the same signal transduction cascades associated with edema.

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“…A variety of agents may have a beneficial effect in reducing injury-resuscitation-induced third-spacing of fluid, such as melatonin, colloids and hypertonic saline [7]. Although many experiments have been designed to prove the effectiveness of these agents in preventing intestinal injury, studies confirming their efficacy in secondary IAH are lacking [8–10]. The objective of this study was to examine the effects of melatonin, 7.5% hypertonic saline (HS), and hydroxyethyl starch 130/0.4 (HES) on secondary IAH in a pathophysiological rat model and the underlying mechanisms involved.…”

Section: Introductionmentioning

confidence: 99%

Comparison of Melatonin, Hypertonic Saline, and Hydroxyethyl Starch for Resuscitation of Secondary Intra-Abdominal Hypertension in an Animal Model

Chang¹,

Tang²,

Liu³

et al. 2016

PLoS ONE

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A variety of agents may have a beneficial effect in reducing injury-induced intestinal edema of fluid, but studies confirming the efficacy and mechanisms of these agents in secondary intra-abdominal hypertension (IAH) are lacking. This study was to compare the effectiveness of melatonin, 7.5% hypertonic saline (HS), and hydroxyethyl starch 130/0.4 (HES) on the resuscitation of secondary IAH in a rat model. Female SD rats were divided into: sham group, shock group, lactated Ringer solution (LR) group, melatonin group, HS group, and HES group. Except for the sham group, all rats underwent a combination of inducing portal hypertension, hemorrhaging to a MAP of 40 mmHg for 2 hr, and using an abdominal restraint device. The collected blood was reinfused and the rats were treated with LR (30ml/h), melatonin (50 mg/kg) + LR, HS (6 ml/kg) + LR, and HES (30 ml/kg) + LR, respectively. The shock group received no fluids. LR was continuously infused for 6hr. The intestinal permeability, immunofluorescence of tight junction proteins, transmission electron microscopy, level of inflammatory mediators (TNF-a, IL-1β, IL-6) and of biochemical markers of oxidative stress (malondialdehyde, myeloperoxidase activity, and glutathione peroxidase) were assessed. Expressions of the protein kinase B (Akt) and of tight junction proteins were detected by Western blot. Compared with LR, HS, and HES, melatonin was associated with less inflammatory and oxidative injury, less intestinal permeability and injury, and lower incidence of secondary IAH in this model. The salutary effect of melatonin in this model was associated with the upregulation of intestinal Akt phosphorylation.

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Hypertonic saline resuscitation prevents hydrostatically induced intestinal edema and ileus

Abstract: Hypertonic saline prevented intestinal tissue edema. In addition, hypertonic saline improved intestinal transit, possibly through more efficient transmission of muscle force through stiffer intestinal tissue.

Cited by 34 publications

References 19 publications

Impact of hypertonic saline on postoperative complications for patients undergoing upper gastrointestinal surgery

Impact of hypertonic saline on postoperative complications for patients undergoing upper gastrointestinal surgery

Hydrostatic intestinal edema induced signaling pathways: Potential role of mechanical forces

Comparison of Melatonin, Hypertonic Saline, and Hydroxyethyl Starch for Resuscitation of Secondary Intra-Abdominal Hypertension in an Animal Model

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