Journal Reading

J Trauma. 2011 May 1; 70(5): S27S29

7.5% Saline and 7.5% Saline/6% Dextran for Hypovolemic Shock

Eileen M. Bulger, MD, FACS Professor of Surgery, University of Washington

Ahimsa Yoga Anindita G0007030

Lecturer : Dr.

Conventional resuscitation of traumatic hemorrhagic shock isotonic (normal saline) or slightly hypotonic (lactated Ringers, LR) Prior animal and human studies hypertonic saline (7.5%) and hypertonic saline-dextran (HSD) (7.5% saline with 6% dextran-70) solutions may reduce mortality

HSD an increase in serum osmotic pressure

redistribution of fluid from the interstitial to the intravascular space.

rapid restoration of circulating intravascular volume

Smaller volume of fluid required compared to isotonic or hypotonic crystalloid solutions and decreased accumulation of extravascular volume

osmotic effect of HSD reduce intracranial pressure

increased systemic perfusion, which increases cerebral perfusion, and a decrease in the intracranial pressure

minimize the progression of secondary brain injury

hypertonicity limit the proinflammatory response of circulating inflammatory cells

modulating the excessive immunoinflammatory response following systemic ischemia/reperfusion injury

Dextran
Reduction of Removal of inflammatory the dextran Effort to prolong the organ injury component circulatory utilizing may enhance hypertonic the antieffect of saline rather inflammatory hypertonicity than HSD effects

SUMMARY OF PREVIOUS CLINICAL TRIALS

Prior to the year 2000

In all trials, there were no significant adverse events, attesting to the safety of this therapy.

250-ml bolus of HSD vs. a standard crystalloid solution

Pre hospital environment survival benefit for patients treated did not reach statistical significance

arrival to the emergency department no difference in survival

Wade et al.

Traditional meta-analysis of all the trials using HSD or hypertonic saline

HSD offers a survival benefit for the treatment of traumatic hypotension but that hypertonic saline alone offered no benefit

two individual patient cohort analyses

1395 patients from previous trials

improvement in overall survival to discharge in the HSD group OR 1.47; 95% CI 1.042.08

223 patients with hypotension and TBI

HSD treatment in these patients resulted in a twofold increase in survival compared to conventional resuscitation

Recent study assessed the effect of hypertonic resuscitation on outcome for patients with both hypotension and severe TBI. 250 cc 7.5% saline without dextran vs. LR solution as the initial prehospital resuscitation fluid and assessed neurologic outcome using the extended Glasgow coma score 6 months after injury. Failed to identify any difference in neurologic outcome Of the patients who survived to the ED, the longterm survival rate was 67% for those receiving hypertonic saline vs. 55% for the LR group (OR = 1.72, 95% CI: 0.953.1, p = 0.073)

2 0 0 5

Trial of HSD vs LR solution following blunt traumatic injury with hypovolemic shock -ARDS-free survival at 28 days-

There was no overall benefit to HSD

resuscitation

Resuscitation Outcomes Consortium (ROC) 20062009

RCT of 250 cc 7.5% saline (hypertonic), 7.5% saline/6% dextran-70 (HSD), or 0.9% saline (NS) as the initial resuscitation fluid administered in the prehospital setting following severe traumatic injury with evidence of either hypovolemic shock or severe TBI

There was no difference in 28-day survival: HSD 74.5%, HS 73.0%, and NS 74.4%, p = 0.91

There was no difference in 6- month neurologic outcome: Glasgow outcome scale extended (GOSE) 4 (death or severe disability) HSD 53.7%, HS 54.3%, and NS 51.5%, p = 0.67

SUMMARY
Despite encouraging preclinical data, clinical trials have failed to show significant benefit for administration of hypertonic fluids along with ongoing crystalloid resuscitation in the civilian community

Yes No Unclear

1 Did the review address a clearly focused issue? 2 Did the authors select the right sort of studies for the review? 3 Do you think the important, relevant studies were included? 4 Did the review's authors do enough to assess the quality of the included studies?

V
V V

Yes 5 6 7 8 9 Were the results similar from study to study? Is there a confidence interval? Can the results be applied to the local population? Were all important outcomes considered? Are the benefits worth the harms and costs? V V V

No

Unclear

Comment : This is a good article, but I think it cant be considered to be applied in Indonesia because there arent such of solution here.