Prognostic Factors to Predict Outcome Following the Administration of Hypertonic/Hyperoncotic Solution in Hypovolemic Patients

Rn, Younes; F, Aun; Ct, Ching; Goldenberg, Dov Charles; Mh, Franco; Fk, Miura; Santos, SS; Im, Sequeiros; M, Rocha e Silva; I, Fujimura; Birolini, D

doi:10.1097/00024382-199702000-00001

Cited by 84 publications

(50 citation statements)

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“…Hypertonic resuscitation has been shown to be effective in restoring circulating plasma volume after a hypovolemic challenge, with an improvement in overall survival (2,18). The factors underlying this improvement are poorly characterized.…”

Section: Discussionmentioning

confidence: 99%

Hypertonic Preconditioning Inhibits Macrophage Responsiveness to Endotoxin

Cuschieri

Gourlay

Garcia

et al. 2002

The Journal of Immunology

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Hypertonic saline has been shown to modulate cell shape and the response of components of the innate immune response. However, the effect of hypertonic saline on the macrophage remains unknown. We hypothesized that hypertonic preconditioning would impair subsequent inflammatory mediator signaling through a reduction in stress fiber polymerization and mitogen-activated protein kinase activity after LPS stimulation. Rabbit alveolar macrophages were stimulated with 100 ng/ml of LPS. Selected cells were preconditioned with 40–100 mM of NaCl, mannitol, or urea for 4 h and returned to isotonic medium before LPS stimulation. Cellular protein was harvested and subjected to Western blot analysis for the dually phosphorylated active forms of p38 and extracellular signal-related kinase (ERK) 1/2. TNF production was determined by an L929 bioassay, and stress fiber polymerization was evaluated by confocal microscopy. Preconditioning of macrophages with NaCl or mannitol resulted in dose-dependent reduction in ERK 1/2 phosphorylation with no effect on p38 phosphorylation. Urea preconditioning had no effect on either mitogen-activated protein kinase. A dose-dependent attenuation of TNF production was seen with NaCl and mannitol preconditioning (p < 0.05), but not with urea. NaCl and mannitol preconditioning resulted in failure of LPS-induced stress fiber polymerization, whereas urea did not. Extracellular hypertonic conditions (i.e., NaCl and mannitol) have an immunomodulatory effect on macrophages, demonstrated through failure of optimal stress fiber polymerization, ERK 1/2 activity, and TNF production. Intracellular hypertonic conditions (i.e., urea) had no significant effect. Hypertonic saline or mannitol resuscitation, therefore, may help protect against multiple-organ dysfunction syndrome as a result of this reduced proinflammatory responsiveness.

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Section: Discussionmentioning

confidence: 99%

Hypertonic Preconditioning Inhibits Macrophage Responsiveness to Endotoxin

Cuschieri

Gourlay

Garcia

et al. 2002

The Journal of Immunology

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“…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.…”

Section: Clinical Experience and Perspectivesmentioning

confidence: 99%

“…75 A significant increase in survival for the HSD treated patients in the subpopulation requiring surgery was shown. It also showed a greater incidence of adult respiratory distress syndrome, renal failure and coagulopathy in the standard-of-care alone treatment group.…”

mentioning

confidence: 94%

Small Volume Hypertonic Resuscitation of Circulatory Shock

Rocha-e-Silva

Figueiredo

2005

Clinics

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Small volume hypertonic resuscitation is a relatively new conceptual approach to shock therapy. It was originally based on the idea that a relatively large blood volume expansion could be obtained by administering a relatively small volume of fluid, taking advantage of osmosis. It was soon realized that the physiological vasodilator property of hypertonicity was a useful byproduct of small volume resuscitation in that it induced reperfusion of previously ischemic territories, even though such an effect encroached upon the malefic effects of the ischemia-reperfusion process. Subsequent research disclosed a number of previously unsuspected properties of hypertonic resuscitation, amongst them the correction of endothelial and red cell edema with significant consequences in terms of capillary blood flow. A whole set of actions of hypertonicity upon the immune system are being gradually uncovered, but the full implication of these observations with regard to the clinical scenario are still under study. Small volume resuscitation for shock is in current clinical use in some parts of the world, in spite of objections raised concerning its safety under conditions of uncontrolled bleeding. These objections stem mainly from experimental studies, but there are few signs that they may be of real clinical significance. This review attempts to cover the earlier and the more recent developments in this field.

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“…The number of patients in the study did not allow for clear evaluation of the impact of hypertonic treatment on immediate and long-term survival. To address the survival issue, a more extensive study with 2 arms (HSD x isotonic saline) was then designed to include a sufficient number of patients 13 . This study evaluated the effects of hypertonic/hyperoncotic solutions infused in the treatment of hypovolemic shock in patients, as well as the subsequent identification of prognostic factors that might more accurately predict the patients who are going to benefit from the administration of hypertonic solutions.…”

Section: Emergency Room Studiesmentioning

confidence: 99%

Hypertonic/hyperoncotic solution in hypovolemic patients: experience in the emergency room

Younes

Birolini

2002

Rev. Hosp. Clin.

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Hypertonic solutions have been studied extensively in the treatment of hypovolemic shock, both in experimental and clinical models. Safety, efficacy, and long-term effects on animals and patients have been evaluated. The present article reviews indications, safety, mortality rates, and outcome in patients with hemorrhagic hypovolemic shock who were treated after admission with a hypertonic/hyperoncotic solution under strict observation in the emergency room.

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Prognostic Factors to Predict Outcome Following the Administration of Hypertonic/Hyperoncotic Solution in Hypovolemic Patients

Cited by 84 publications

References 0 publications

Hypertonic Preconditioning Inhibits Macrophage Responsiveness to Endotoxin

Hypertonic Preconditioning Inhibits Macrophage Responsiveness to Endotoxin

Small Volume Hypertonic Resuscitation of Circulatory Shock

Hypertonic/hyperoncotic solution in hypovolemic patients: experience in the emergency room

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