Hypertonic Saline Resuscitation Restores Inflammatory Cytokine Balance in Post-Traumatic Hemorrhagic Shock Patients

摘要

Fluid resuscitation can often exacerbate injury sustained during hemorrhagic shock and is associated with altered immuno-inflammatory events. Early monocyte dysregulation and excessive pro-inflammatory cytokine production are thought to play a key role in the development ofpost-traumatic multi-organ dysfunction in resuscitated trauma patients. Compared with standard isotonic crystalloid resuscitation using 0.9% normal saline (NS), 7.5% hypertonic saline with 6% dexiran-70 (HSD) has been shown in experimental studies to reduce shock/resuscitation- inducedinflammatory reactions and lessen organ dysfunction. However, the immunomodulatory capacity of HSD, has not been evaluated in clinical human trials. In this prospective, randomized controlled trial we show that a single (250 mL) bolus infusion of HSD in hemorrhagic trauma patients restores the balance between pro- and anti-inflammatory mediators in the early post-resuscitative period.