Small‐volume resuscitation: from experimental evidence to clinical routine. Advantages and disadvantages of hypertonic solutions

Kreimeier, U.; Meßmer, K.

doi:10.1034/j.1399-6576.2002.460601.x

Cited by 112 publications

(86 citation statements)

References 79 publications

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“…In clinical studies addressing hypovolemic conditions, HS has been administered intravenously (14). In this study, we chose the intraperitoneal route for administration of HS or NS for practical reasons.…”

Section: Discussionmentioning

confidence: 99%

Hypertonic saline reduces neutrophil-epithelial interactions in vitro and gut tissue damage in a mouse model of colitis

Tillinger¹,

McCole²,

Keely³

et al. 2008

American Journal of Physiology-Regulatory, Integrative and Comp

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Hypertonic saline (HS) exerts various inhibitory effects on PMN function. We hypothesized that HS could inhibit transepithelial migration of PMN and thereby prevent inflammatory events in experimental colitis. Isolated human PMN were treated with HS (40 mM), and their transmigration across a monolayer of T84 epithelial cells was induced by N-formyl-methionyl-leucyl-phenylalanine. Monolayer disruption was assessed by monitoring changes in transepithelial conductance in an Ussing chamber. Colitis in mice was induced by oral administration of dextran sulfate sodium (DSS). Animals were treated with 4 or 8 ml/kg of 7.5% saline intraperitoneally two times daily for 7 days. Controls received equivalent volumes of normal saline (NS, n ϭ 6) or no intraperitoneal treatment (DSS, n ϭ 12). The severity of inflammation was evaluated based on disease activity index and histology score. HS treatment of PMN in vitro significantly reduced cell migration and the disruption of T84 monolayers compared with untreated control cells (n ϭ 5, P Ͻ 0.05). This effect of HS was dose dependent. HS treatment in vivo also reduced colitis-induced gut tissue damage, as indicated by an improved histology score compared with the NS and DSS groups. We conclude that HS inhibits transepithelial migration of PMN in vitro and gut tissue damage in vivo in a mouse model of colitis. Thus HS may have clinical value to reduce PMN-mediated intestinal damage. neutrophil activation; inflammatory bowel disease; hypertonic saline solution; inflammation; epithelium ALTHOUGH INFLAMMATORY DISEASES of the intestine are etiologically diverse, many of these diseases express similar histological features. Accumulation of neutrophils [polymorphonuclear neutrophils (PMN)] in the lamina propria is a major hallmark of the acute inflammatory response in disorders ranging from inflammatory bowel disease (IBD) to shock-induced gut dysfunction. In IBD, PMN also transmigrate from the lamina propria in the gut lumen. By measuring fecal excretion of leukocytes labeled with indium-111, migration of PMN from the circulation in the diseased intestine has been estimated to be increased by at least 10-fold in IBD patients (23). PMN are rapidly recruited from the bloodstream by cell adhesion to the vascular endothelium, transendothelial migration, and chemotaxis to the local inflammatory site. After their recruitment to such sites, PMN exert cytotoxic effects that can damage gut tissues via the release of cytotoxic mediators. A complex assortment of these cytotoxic agents, including reactive oxygen metabolites and proteolytic enzymes, is released during this inflammatory process and causes host tissue damage. In addition, PMN can further modulate such inflammatory processes by immunoregulatory functions they exert via the secretion of several important cytokines, including interleukin (IL)-1, IL-1 receptor antagonist, IL-6, IL-8, tumor necrosis factor-␣, granulocyte colony-stimulating factor and granulocyte macrophage colony-stimulating factor (15).The transepithelial migration of PMN...

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Section: Discussionmentioning

confidence: 99%

Hypertonic saline reduces neutrophil-epithelial interactions in vitro and gut tissue damage in a mouse model of colitis

Tillinger¹,

McCole²,

Keely³

et al. 2008

American Journal of Physiology-Regulatory, Integrative and Comp

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“…With the combination of a macromolecule and hypertonic NaCl, molecules remain a longer time in the intravascular space, increasing colloid osmotic pressure and plasma volume. Fluid is absorved from the interstitial intracellular space allowing for a more lasting restoration of blood volume 6,14 . This study showed short-term results of volume replacement using two different solutions in hypovolemia.…”

Section: Discussionmentioning

confidence: 99%

Hemodynamic effects of volume replacement with saline solution and hypertonic hydroxyethyl starch in dogs

et al. 2009

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Purpose: To investigate hemodynamic response to volume replacement with saline solution and hypertonic hydroxyethyl starch in hypovolemic dogs. Methods: Forty dogs under general anesthesia and hemodynamic monitoring, following measurements at baseline, were bled 20 ml.Kg -1 and parameters were measured again after 10 minutes. The animals were randomly divided in two groups and volume replacement was performed with saline solution twice the volume removed or 4 ml.Kg -1 of hypertonic hydroxyethyl starch. Hemodynamic data were again measured after 5, 15, 30, 45 and 60 minutes. Results: With both solutions values returned to satisfactory hemodynamic levels. With saline solution, there was a greater amplitude in variations that tended to decrease progressively. With hypertonic hydroxyethyl starch, the parameters studied returned more rapidly to levels similar to those at baseline and varied less. Conclusion: Both solutions proved to be efficient at replacing volume in the short period studied, although hypertonic hydroxyethyl starch produced more stable results. Key words: Hemodynamics. Hypovolemia. Hetastarch. Saline Solution, Hypertonic. Dogs. RESUMOObjetivo: Avaliar em cães hipovolêmicos as respostas hemodinâmicas da reposição volêmica com solução salina e hidroxi-etil amido hipertônico. Métodos: Quarenta cães sob anestesia geral e monitorização hemodinâmica, após medidas em repouso foram sangrados 20 ml.Kg -1 e tiveram os parâmetros novamente medidos após 10 minutos. Os animais foram aleatoriamente divididos em dois grupos nos quais foi realizada reposição volêmica com solução fisiológica duas vezes o volume retirado ou 4 ml.Kg -1 de hidroxi-etil amido hipertônico e os dados hemodinâmicos medidos novamente após 5, 15, 30, 45 e 60 minutos. Resultados: A reposição volêmica com as duas soluções fez os valores retornarem a níveis hemodinâmicos satisfatórios, a amplitude das variações com solução fisiológica foi maior, mas tendeu a diminuir progressivamente, com o hidroxi-etil amido hipertônico os parâmetros estudados retornaram a semelhantes ao repouso mais rapidamente e variaram menos. Conclusão: Ambas soluções se mostraram eficientes na reposição volêmica, o hidroxi-etil amido hipertônico proporcionou resultados mais estáveis.

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“…Противопоказаниями для включения в исследование служи ли: возможность рецидива кровотечения и неадекватность респираторной поддержки с нестабильностью респиратор ных показателей. Для коррекции гипотензии внутривенно вводили по 4 мл/кг 7,5% раствора хлорида натрия и раство ра гидроксиэтилкрахмала («Венофундин») [7,8,11] с после дующей инфузионной и, по показаниям, инотропной под держкой гемодинамики на протяжении 6 часов. Полученные результаты оценивали с позиций целевых значений ЕGDT для среднего артериального давления (АД), центрального венозного давления (ЦВД), насыщения кислородом веноз ной крови в центральной вене (ScvO 2 ) и диуреза.…”

Section: материалы и методыunclassified

“…Так, при коррекции тяжелых нарушений крово обращения, изоосмолярные кристаллоидные и колло идные растворы часто приходится применять в боль ших объемах, что связано с риском перегрузки сердца и увеличением отека легких и кишечника [6]. В этой свя зи представляют интерес возможности восстановления кровообращения малыми объемами гипертонических растворов (small volume hypertonic resuscitation) на ос нове 7,5% раствора хлорида натрия (ГР) [7]. Основной механизм действия ГР заключается в первичной акти вации капиллярного кровотока при мобилизации жид кости из отекших клеток эндотелия, эритроцитов и ин терстиция в сосудистое русло за счет создания осмотического градиента между этими клетками, ин терстицием и плазмой крови.…”

unclassified

“…Из за кратковременности непосредственного гемодинамического эффекта ГР (не более одного часа), его комбинируют с декстраном или гидроксиэтилкрах малом с последующим поддержанием и окончательной стабилизацией гемодинамики за счет инфузионной и, при необходимости, ино (вазо )тропной терапии. В экс перименте и клинике у больных с массивной кровопо терей и травмой действие ГР проявляется в быстрой нормализации центральной гемодинамики, восстанов лении капиллярного кровотока, противоишемической защите мозга, почек и кишечника [7,8].…”

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Correction of Hemodynamics with Hypertonic Sodium Chloride Solution in Critical Conditions

Жбанников¹,

Забусов²,

Михин³

et al. 2007

rmt

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Small‐volume resuscitation: from experimental evidence to clinical routine. Advantages and disadvantages of hypertonic solutions

Cited by 112 publications

References 79 publications

Hypertonic saline reduces neutrophil-epithelial interactions in vitro and gut tissue damage in a mouse model of colitis

Hypertonic saline reduces neutrophil-epithelial interactions in vitro and gut tissue damage in a mouse model of colitis

Hemodynamic effects of volume replacement with saline solution and hypertonic hydroxyethyl starch in dogs

Correction of Hemodynamics with Hypertonic Sodium Chloride Solution in Critical Conditions

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