Hypertonic saline in critical care: A review of the literature and guidelines for use in hypotensive states and raised intracranial pressure

Anaesthesia

Volumn 64, Issue 9, 2009, Pages 990-1003

  Strandvik, Gustav F ^a  

^a South Eastern School of Anaesthesia   (United Kingdom)

Author keywords

[No Author keywords available]

Indexed keywords

ALBUMIN; BICARBONATE; DEXTRAN DERIVATIVE; GLUCOSE; HETASTARCH; HYPERTONIC SALINE DEXTRAN; MANNITOL; RINGER LACTATE SOLUTION; SODIUM CHLORIDE; UNCLASSIFIED DRUG;

ACUTE HEART FAILURE; BLOOD PRESSURE REGULATION; BOLUS INJECTION; CARDIOGENIC SHOCK; CENTRAL PONTINE MYELINOLYSIS; CONTINUOUS INFUSION; DRUG EFFECT; DRUG EFFICACY; DRUG MECHANISM; DRUG SAFETY; HEMORRHAGIC SHOCK; HUMAN; HYPERCHLOREMIC ACIDOSIS; HYPOKALEMIA; HYPOTENSION; HYPOVOLEMIC SHOCK; INTENSIVE CARE; INTRACRANIAL HYPERTENSION; KIDNEY FAILURE; LIVER FAILURE; LUNG EDEMA; MORTALITY; NONHUMAN; PRACTICE GUIDELINE; REVIEW; SEPSIS; STROKE; SUBARACHNOID HEMORRHAGE; SURVIVAL; TRAUMATIC BRAIN INJURY; TREATMENT OUTCOME;

CRITICAL CARE; EVIDENCE-BASED MEDICINE; HUMANS; HYPOTENSION; INTRACRANIAL HYPERTENSION; PRACTICE GUIDELINES AS TOPIC; SALINE SOLUTION, HYPERTONIC; SHOCK; TREATMENT OUTCOME;

EID: 68149101399     PISSN: 00032409     EISSN: 13652044     Source Type: Journal    
DOI: 10.1111/j.1365-2044.2009.05986.x     Document Type: Review

References (103)

1. Sutherland WD, McCay D. Observations on the inhibitory influence exerted by hypertonic saline solutions and calcium chloride solutions on the action of specific haemolysins, with suggestions as to the therapy of blackwater fever. Biochemical Journal 1911; 5: 1-22.
2. Weed MP, McKibben LH. Experimental alteration of brain bulk. The American Journal of Physiology 1919; XLVIII: 531-560
3. Sapirstein LA, Brandt WL, Drury DR. Production of arterial hypertension in the rat by substitution of hypertonic sodium chloride solutions for drinking water. The American Journal of Medicine 1950; 8: 525-526
4. de Felippe J, Timoner J, Velasco IT, Lopes OU, Rochae- Silva M. Treatment of refractory hypovolaemic shock by 7.5% sodium chloride injections. The Lancet 1980; 2: 1002-1004 (Pubitemid 10025072)
5. Oliveira RP, Velasco I, Soriano F, Friedman G. Clinical review: hypertonic saline resuscitation in sepsis. Critical Care 2002; 6: 418-423
6. Rizoli SB, Rhind SG, Shek PN, et al. The immunomodulatory effects of hypertonic saline resuscitation in patients sustaining traumatic hemorrhagic shock: a randomized, controlled, double-blinded trial. Annals of Surgery 2006; 243: 47-57.
7. Harbour R, Miller J. A new system for grading recommendations in evidence based guidelines. British Medical Journal 2001; 323: 334-336 (Pubitemid 32744465)
8. Scottish Intercollegiate Guidelines Network. http:// www.sign.ac.uk (accessed 23/12/2008)
9. Johnson AL, Criddle LM. Pass the salt: indications for and implications of using hypertonic saline. Critical Care Nurse 2004; 24: 36-38
10. Himmelseher S. Hypertonic saline solutions for treatment of intracranial hypertension. Current Opinion in Anaesthesiology 2007; 20: 414-426 (Pubitemid 47415132)
11. Suarez JI. Hypertonic saline for cerebral edema and elevated intracranial pressure. Cleveland Clinic Journal of Medicine 2004; 71 (Suppl. 1): S9-13.
12. Sapsford W. Hypertonic saline dextran - the fluid of choice in the resuscitation of haemorrhagic shock? Journal of the Royal Army Medical Corps 2003; 149: 110-120
13. de Carvalho WB. Hypertonic solutions for pediatric patients. Jornal de Pediatria (Rio Jornal) 2003; 79 (Suppl. 2): S187-94.
14. Rocha-e-Silva M, Poli de Figueiredo LF. Small volume hypertonic resuscitation of circulatory shock. Clinics (Sao Paulo, Brazil) 2005; 60: 159-172
15. Murphy N, Auzinger G, Bernel W, Wendon J. The effect of hypertonic sodium chloride on intracranial pressure in patients with acute liver failure. Hepatology 2004; 39: 464-470 (Pubitemid 38222187)
16. Jarvela K, Koskinen M, Koobi T. Effects of hypertonic saline (7.5%) on extracellular fluid volumes in healthy volunteers. Anaesthesia 2003; 58: 878-881
17. Thompson R, Greaves I. Hypertonic saline-hydroxyethyl starch in trauma resuscitation. Journal of the Royal Army Medical Corps 2006; 152: 6-12.
18. Levine JM. Hypertonic saline for the treatment of intracranial hypertension: worth its salt. Critical Care Medicine 2006; 34: 3037-3039 (Pubitemid 44808753)
19. Zhao L, Wang B, You G, Wang Z, Zhou H. Effects of different resuscitation fluids on the rheologic behavior of red blood cells, blood viscosity and plasma viscosity in experimental hemorrhagic shock. Resuscitation 2009; 80: 253-258
20. Hannemann L, Schaffartzik W, Meier-Hellmann A, Reinhart K. Effects of hypertonic saline on the pulmonary gas exchange. Advances in Experimental Medicine and Biology 1994; 345: 101-104 (Pubitemid 24145737)
21. Ziai WC, Toung TJ, Bhardwaj A. Hypertonic saline: first-line therapy for cerebral edema? Journal of the Neurological Sciences 2007; 261: 157-166
22. Al-Rawi PG, Zygun D, Tseng MY, et al. Cerebral blood flow augmentation in patients with severe subarachnoid haemorrhage. Acta Neurochirurgica Supplement 2005; 95: 123-127
23. Wenner MM, Rose WC, Delaney EP, Stillabower ME, Farquhar WB. Influence of plasma osmolality on baroreflex control of sympathetic activity. American Journal of Physiology. Heart and Circulatory Physiology 2007; 293: H2313-9.
24. Vialet R, Albanese J, Thomachot L, et al. Isovolume hypertonic solutes (sodium chloride or mannitol) in the treatment of refractory posttraumatic intracranial hypertension: 2 mL/kg 7.5% saline is more effective than 2 mL/kg 20% mannitol. Critical Care Medicine 2003; 31: 1683-1687 (Pubitemid 36714221)
25. Boldt J, Zickmann B, Ballesteros M, Herold C, Dapper F, Hempelmann G. Cardiorespiratory responses to hypertonic saline solution in cardiac operations. The Annals of Thoracic Surgery 1991; 51: 610-615
26. Nydam TL, Moore EE, McIntyre RC, et al. Hypertonic saline attenuates TNF-alpha-induced NF-kappaB activation in pulmonary epithelial cells. Shock 2009; 33: 466-472
27. Papia G, Burrows LL, Sinnadurai S, et al. Hypertonic saline resuscitation from hemorrhagic shock does not impair the neutrophil response to intraabdominal infection. Surgery 2008; 144: 814-821
28. Lu YQ, Huang WD, Cai XJ, Gu LH, Mou HZ. Hypertonic saline resuscitation reduces apoptosis of intestinal mucosa in a rat model of hemorrhagic shock. Journal of Zhejiang University Science B 2008; 9: 879-884
29. Jacob M, Bruegger D, Rehm M, Welsch U, Conzen P, Becker BF. Contrasting effects of colloid and crystalloid resuscitation fluids on cardiac vascular permeability. Anesthesiology 2006; 104: 1223-1231 (Pubitemid 43852956)
30. Oda J, Ueyama M, Yamashita K, et al. Hypertonic lactated saline resuscitation reduces the risk of abdominal compartment syndrome in severely burned patients. The Journal of Trauma 2006; 60: 64-71.
31. Harutjunyan L, Holz C, Rieger A, Menzel M, Grond S, Soukup J. Efficiency of 7.2% hypertonic saline hydroxyethyl starch 200/0.5 versus mannitol 15% in the treatment of increased intracranial pressure in neurosurgical patients - a randomized clinical trial. Critical Care 2005; 9: R530-40.
32. Crile GW. The present status of anociation: a critical review. Annals of Surgery 1927; 86: 251-254
33. Moore FA, McKinley BA, Moore EE. The next generation in shock resuscitation. The Lancet 2004; 363: 1988-1996
34. Rivers E, Nguyen B, Havstad S, et al. Early goal-directed therapy in the treatment of severe sepsis and septic shock. The New England Journal of Medicine 2001; 345: 1368-1377 (Pubitemid 34940725)
35. Finfer S, Bellomo R, Boyce N, French J, Myburgh J, Norton R. A comparison of albumin and saline for fluid resuscitation in the intensive care unit. The New England Journal of Medicine 2004; 350: 2247-2256 (Pubitemid 38669207)
36. Bickell WH, Wall MJ Jr, Pepe PE, et al. Immediate versus delayed fluid resuscitation for hypotensive patients with penetrating torso injuries. The New England Journal of Medicine 1994; 331: 1105-1109
37. Boldt J, Zickmann B, Thiel A, Herold C, Dapper F, Hempelmann G. Hyperosmolar volume replacement in heart surgery. Anaesthesist 1990; 39: 412-419
38. McNamara JJ, Molot MD, Dunn RA, Stremple JF. Effect of hypertonic glucose in hypovolemic shock in man. Annals of Surgery 1972; 176: 247-250
39. Vassar MJ, Perry CA, Gannaway WL, Holcroft JW. 7.5% sodium chloride/dextran for resuscitation of trauma patients undergoing helicopter transport. Archives of Surgery 1991; 126: 1065-1072
40. Younes RN, Aun F, Accioly CQ, et al. Hypertonic solutions in the treatment of hypovolemic shock: a prospective, randomized study in patients admitted to the emergency room. Surgery 1992; 111: 380-385
41. Vassar MJ, Fischer RP, O'Brien PE, et al. A multicenter trial for resuscitation of injured patients with 7.5% sodium chloride. The effect of added dextran 70. The Multicenter Group for the Study of Hypertonic Saline in Trauma Patients. Archives of Surgery 1993; 128: 1003-1011
42. Younes RN, Birolini D. Hypertonic/hyperoncotic solution in hypovolemic patients: experience in the emergency room. Revista do Hospital das Clinicas 2002; 57: 124-128
43. Alpar EK, Killampalli VV. Effects of hypertonic dextran in hypovolaemic shock: a prospective clinical trial. Injury 2004; 35: 500-506
44. Vassar MJ, Perry CA, Holcroft JW. Prehospital resuscitation of hypotensive trauma patients with 7.5% NaCl versus 7.5% NaCl with added dextran: a controlled trial. The Journal of Trauma 1993; 34: 622-632
45. Wade CE, Grady JJ, Kramer GC. Efficacy of hypertonic saline dextran fluid resuscitation for patients with hypotension from penetrating trauma. The Journal of Trauma 2003; 54: S144-8.
46. Chavez-Negrete A, Majluf Cruz S, Frati Munari A, Perches A, Arguero R. Treatment of hemorrhagic shock with intraosseous or intravenous infusion of hypertonic saline dextran solution. European Surgical Research 1991; 23: 123-129
47. Ghafari MH, Moosavizadeh SA, Moharari RS, Khashayar P. Hypertonic saline 5% vs. lactated ringer for resuscitating patients in hemorrhagic shock. Middle East Journal of Anesthesiology 2008; 19: 1337-1347
48. Bortolani A, Governa M, Barisoni D. Fluid replacement in burned patients. Acta Chirurgiae Plasticae 1996; 38: 132-136
49. Gunn ML, Hansbrough JF, Davis JW, Furst SR, Field TO. Prospective, randomized trial of hypertonic sodium lactate versus lactated Ringer's solution for burn shock resuscitation. The Journal of Trauma 1989; 29: 1261-1267
50. Gong R, Lindberg J, Abrams J, Whitaker WR, Wade CE, Gouge S. Comparison of hypertonic saline solutions and dextran in dialysis-induced hypotension. Journal of the American Society of Nephrology 1993; 3: 1808-1812
51. Van der Sande FM, Luik AJ, Kooman JP, Verstappen V, Leunissen KM. Effect of intravenous fluids on blood pressure course during hemodialysis in hypotensive-prone patients. Journal of the American Society of Nephrology 2000; 11: 550-555 (Pubitemid 30115085)
52. Schroth M, Plank C, Meissner U, et al. Hypertonichyperoncotic solutions improve cardiac function in children after open-heart surgery. Pediatrics 2006; 118: e76-84. (Pubitemid 46074626)
53. Oliveira SA, Bueno RM, Souza JM, Senra DF, Rochae- Silva M. Effects of hypertonic saline dextran on the postoperative evolution of Jehovah's Witness patients submitted to cardiac surgery with cardiopulmonary bypass. Shock 1995; 3: 391-394
54. Rocha ESR, Caneo LF, Lourenco Filho DD, et al. First use of hypertonic saline dextran in children: a study in safety and effectiveness for atrial septal defect surgery. Shock 2003; 20: 427-430
55. Wang BW, Chiou YH, Chen WB, Peng TY, Leung HK. Intravenous pretreatment of hypertonic saline can prevent systemic hypotension induced by spinal anesthesia. Acta Anaesthesiologica Sinica 1997; 35: 85-90.
56. Jarvela K, Koobi T, Kauppinen P, Kaukinen S. Effects of hypertonic 75 mg/ml (7.5%) saline on extracellular water volume when used for preloading before spinal anaesthesia. Acta Anaesthesiologica Scandinavica 2001; 45: 776-781
57. Veroli P, Benhamou D. Comparison of hypertonic saline (5%), isotonic saline and Ringer's lactate solutions for fluid preloading before lumbar extradural anaesthesia. British Journal of Anaesthesia 1992; 69: 461-464
58. Oliveira RP, Weingartner R, Ribas EO, Moraes RS, Friedman G. Acute haemodynamic effects of a hypertonic saline/dextran solution in stable patients with severe sepsis. Intensive Care Medicine 2002; 28: 1574-1581 (Pubitemid 36002504)
59. Fang ZX, Li YF, Zhou XQ, et al. Effects of resuscitation with crystalloid fluids on cardiac function in patients with severe sepsis. BMC Infectious Diseases 2008; 8: 50.
60. Wade C, Grady J, Kramer G. Efficacy of hypertonic saline dextran (HSD) in patients with traumatic hypotension: meta-analysis of individual patient data. Acta Anaesthesiologica Scandinavica. Supplumentum 1997; 110: 77-79
61. Bunn F, Roberts I, Tasker R, Trivedi D. Hypertonic versus near isotonic crystalloid for fluid resuscitation in critically ill patients. Cochrane Database of Systematic Reviews 2007; CD002045.
62. Perel P, Roberts I. Colloids versus crystalloids for fluid resuscitation in critically ill patients. Cochrane Database of Systematic Reviews 2007; CD000567.
63. Mattox KL, Maningas PA, Moore EE, et al. Prehospital hypertonic saline/dextran infusion for post-traumatic hypotension. The USA Multicenter Trial. Annals of Surgery 1991; 213: 482-491
64. Horne G, Schemitsch E. Assessment of the survivors of major trauma accidents. The Australian and New Zealand Journal of Surgery 1989; 59: 465-470 (Pubitemid 19144509)
65. Bulger EM, Jurkovich GJ, Nathens AB, et al. Hypertonic resuscitation of hypovolemic shock after blunt trauma: a randomized controlled trial. Archives of Surgery 2008; 143: 139-148 discussion 49.
66. Miller JD, Becker DP, Ward JD, et al. Significance of intracranial hypertension in severe head injury. Journal of Neurosurgery 1977; 47: 503-516 (Pubitemid 8193896)
67. Ogden AT, Mayer SA, Connolly ES. Hyperosmolar agents in neurosurgical practice: the evolving role of hypertonic saline. Neurosurgery 2005; 57: 207-15. discussion - 15.
68. Horn P, Munch E, Vajkoczy P, et al. Hypertonic saline solution for control of elevated intracranial pressure in patients with exhausted response to mannitol and barbiturates. Neurological Research 1999; 21: 758-764
69. Battison C, Andrews PJ, Graham C, Petty T. Randomized, controlled trial on the effect of a 20% mannitol solution and a 7.5% saline/6% dextran solution on increased intracranial pressure after brain injury. Critical Care Medicine 2005; 33: 196-202. (Pubitemid 40116557)
70. Schatzmann C, Heissler HE, Konig K, et al. Treatment of elevated intracranial pressure by infusions of 10% saline in severely head injured patients. Acta Neurochirurgica. Supplement 1998; 71: 31-33 (Pubitemid 128444348)
71. Khanna S, Davis D, Peterson B, et al. Use of hypertonic saline in the treatment of severe refractory posttraumatic intracranial hypertension in pediatric traumatic brain injury. Critical Care Medicine 2000; 28: 1144-1151 (Pubitemid 30262092)
72. Hartl R, Ghajar J, Hochleuthner H, Mauritz W. Hypertonic/hyperoncotic saline reliably reduces ICP in severely head-injured patients with intracranial hypertension. Acta Neurochirurgica. Supplement 1997; 70: 126-129 (Pubitemid 127502072)
73. Munar F, Ferrer AM, de Nadal M, et al. Cerebral hemodynamic effects of 7.2% hypertonic saline in patients with head injury and raised intracranial pressure. Journal of Neurotrauma 2000; 17: 41-51. (Pubitemid 30075615)
74. Francony G, Fauvage B, Falcon D, et al. Equimolar doses of mannitol and hypertonic saline in the treatment of increased intracranial pressure. Critical Care Medicine 2008; 36: 795-800.
75. Cooper DJ, Myles PS, McDermott FT, et al. Prehospital hypertonic saline resuscitation of patients with hypotension and severe traumatic brain injury: a randomized controlled trial. JAMA: The Journal of the American Medical Association 2004; 291: 1350-1357
76. Fisher B, Thomas D, Peterson B. Hypertonic saline lowers raised intracranial pressure in children after head trauma. Journal of Neurosurgical Anesthesiology 1992; 4: 4-10.
77. Shackford SR, Bourguignon PR, Wald SL, et al. Hypertonic saline resuscitation of patients with head injury: a prospective, randomized clinical trial. The Journal of Trauma 1998; 44: 50-58 (Pubitemid 28095820)
78. Simma B, Burger R, Falk M, Sacher P, Fanconi S. A prospective, randomized, and controlled study of fluid management in children with severe head injury: lactated Ringer's solution versus hypertonic saline. Critical Care Medicine 1998; 26: 1265-1270 (Pubitemid 28334983)
79. Ichai C, Armando G, Orban JC, et al. Sodium lactate versus mannitol in the treatment of intracranial hypertensive episodes in severe traumatic brain-injured patients. Intensive Care Medicine 2009; 35: 471-479
80. Peterson B, Khanna S, Fisher B, Marshall L. Prolonged hypernatremia controls elevated intracranial pressure in head-injured pediatric patients. Critical Care Medicine 2000; 28: 1136-1143 (Pubitemid 30262091)
81. Bentsen G, Breivik H, Lundar T, Stubhaug A. Predictable reduction of intracranial hypertension with hypertonic saline hydroxyethyl starch: a prospective clinical trial in critically ill patients with subarachnoid haemorrhage. Acta Anaesthesiologica Scandinavica 2004; 48: 1089-1095 (Pubitemid 39274124)
82. Tseng MY, Al-Rawi PG, Czosnyka M, et al. Enhancement of cerebral blood flow using systemic hypertonic saline therapy improves outcome in patients with poorgrade spontaneous subarachnoid hemorrhage. Journal of Neurosurgery 2007; 107: 274-282 (Pubitemid 47219369)
83. Bentsen G, Breivik H, Lundar T, Stubhaug A. Hypertonic saline (7.2%) in 6% hydroxyethyl starch reduces intracranial pressure and improves hemodynamics in a placebo-controlled study involving stable patients with subarachnoid hemorrhage. Critical Care Medicine 2006; 34: 2912-2917
84. Schwarz S, Schwab S, Bertram M, Aschoff A, Hacke W. Effects of hypertonic saline hydroxyethyl starch solution and mannitol in patients with increased intracranial pressure after stroke. Stroke 1998; 29: 1550-1555 (Pubitemid 28365572)
85. Schwarz S, Georgiadis D, Aschoff A, Schwab S. Effects of hypertonic (10%) saline in patients with raised intracranial pressure after stroke. Stroke 2002; 33: 136-140
86. De Vivo P, Del Gaudio A, Ciritella P, et al. Hypertonic saline solution: a safe alternative to mannitol 18% in neurosurgery. Minerva Anestesiologica 2001; 67: 603-611
87. Mauritz W, Janciak I, Wilbacher I, Rusnak M. Severe traumatic brain injury in Austria IV: intensive care management. Wiener Klinische Wochenschrift 2007; 119: 46-55. (Pubitemid 46972109)
88. White H, Cook D, Venkatesh B. The use of hypertonic saline for treating intracranial hypertension after traumatic brain injury. Anesthesia and Analgesia 2006; 102: 1836-1846 (Pubitemid 43799864)
89. Smith JE, Hall MJ. Hypertonic saline. Journal of the Royal Army Medical Corps 2004; 150: 239-243
90. Kolsen-Petersen JA, Nielsen JO, Tonnesen E. Acid base and electrolyte changes after hypertonic saline (7.5%) infusion: a randomized controlled clinical trial. Scandinavian Journal of Clinical and Laboratory Investigation 2005; 65: 13-22. (Pubitemid 40278308)
91. Huang PP, Stucky FS, Dimick AR, Treat RC, Bessey PQ, Rue LW. Hypertonic sodium resuscitation is associated with renal failure and death. Annals of Surgery 1995; 221: 543-54. discussion 54-57
92. Knapp JM. Hyperosmolar therapy in the treatment of severe head injury in children: mannitol and hypertonic saline. AACN Clinical Issues 2005; 16: 199-211.
93. Maningas PA, Mattox KL, Pepe PE, et al. Hypertonic saline-dextran solutions for the prehospital management of traumatic hypotension. American Journal of Surgery 1989; 157: 528-33. discussion 33-34
94. Vassar MJ, Perry CA, Holcroft JW. Analysis of potential risks associated with 7.5% sodium chloride resuscitation of traumatic shock. Archives of Surgery 1990; 125: 1309-1315
95. Koenig MA, Bryan M, Lewin JL, et al. Reversal of transtentorial herniation with hypertonic saline. Neurology 2008; 70: 1023-1029
96. Holcroft JW, Vassar MJ, Perry CA, Gannaway WL, Kramer GC. Perspectives on clinical trials for hypertonic saline/dextran solutions for the treatment of traumatic shock. Brazilian Journal of Medical and Biological Research 1989; 22: 291-293
97. Qureshi AI, Suarez JI, Bhardwaj A, et al. Use of hypertonic (3%) saline/acetate infusion in the treatment of cerebral edema: effect on intracranial pressure and lateral displacement of the brain. Critical Care Medicine 1998; 26: 440-446
98. Pascual JL, Maloney-Wilensky E, Reilly PM, et al. Resuscitation of hypotensive head-injured patients: is hypertonic saline the answer? The American Surgeon 2008; 74: 253-259
99. Charalambous MP, Swoboda SM, Lipsett PA. Perioperative hypertonic saline may reduce postoperative infections and lower mortality rates. Surgical Infections (Larchmt) 2008; 9: 67-74.
100. Wenham TN, Hormis AP, Andrzejowski JC. Hypertonic saline after traumatic brain injury in UK neuro-critical care practice. Anaesthesia 2008; 63: 558-559
101. Dean NP, Boslaugh S, Adelson PD, Pineda JA, Leonard JR. Physician agreement with evidence-based recommendations for the treatment of severe traumatic brain injury in children. Journal of Neurosurgery 2007; 107: 387-391
102. Froelich M, Hartl R. Ultra-early hyperosmolar treatment in traumatic brain injury: will surgery soon be old-school? Critical Care Medicine 2008; 36: 642-643
103. Brasel KJ, Bulger E, Cook AJ, et al. Hypertonic resuscitation: design and implementation of a prehospital intervention trial. Journal of the American College of Surgeons 2008; 206: 220-232