Use of Moderately Hypertonic Sodium Chloride in the Resuscitation of Patients from Injury

摘要

One of the main causes of death following traumatic injury has been hemorrhagic shock. Based on numerous studies in animal models and in burn shock patients, there has been considerable interest in evaluating the efficacy of hypertonic sodium chloride solutions in the resuscitation for traumatic injury. The purpose of this contract was to initiate the clinical evaluation of a 3% sodium chloride (3% NaCl) solution versus resuscitation with standard isotonic solutions. Twenty hemodynamically unstable trauma patients were entered into the study. Each patient had received isotonic solutions in the hour before entry. All patients had received at least 6 liters of crystalloid and 2 units of blood since their injury. Studies were initiated within the first six hours after injury. Ten patients then received 3% NaCl, in addition to isotonic fluids as needed to maintain urine output and blood pressure. Ten patients served as controls and received isotonicfluids only. There was significant improvement in urine output and more rapid correction of metabolic acidosis in the patients treated with 3% NaCl. Pulmonary function, remained stable throughout the first 24 hours in the 3% NaCl group. The PaO2/FiO2 indices deteriorated significantly in the isotonic treatment group. These beneficial effects support the experimental models that demonstrate superiorities of small volumes of hypertonic solutions in resuscitation from shock.