Hypertonic saline has anti-inflammatory and laudable immunomodulatory effects in animal models of hemorrhagic shock. These animal models demonstrate decreased lung and intestinal injury after hypertonic saline resuscitation.21,22,39 Similar antiinflammatory effects are also seen in small human trials.39 In trauma patients, hypertonic
saline has the additional benefit of acting as an osmotic agent to decrease cerebral edema in patients with TBI.40,41 Because hypertonic solutions are retained more in the intravascular space, they have the potential to decrease risks of ACS andARDS. Unfortunately, human clinical trials to date have not consistently found a benefit to hypertonic saline over isotonic fluids in the prehospital or acute resuscitation phase after traumatic injury.42–45 Although an analysis of blunt trauma patients receiving hypertonic saline in conjunction withMTshowed an improvement in ARDS-free survival
(HR, 2.18; CI, 1.09–4.36),42 a larger follow-up multicenter randomized controlled trial in trauma patients with hypovolemic shock found no survival or morbidity benefit compared with normal saline.43 Subgroup analysis also revealed significantly increased mortality among the subset of patients who did not require a blood transfusion in the first 24 hours.43 Additional studies of trauma patients with TBI also failed to demonstrate any improvement in mortality or neurologic outcomes
Hypertonic saline has anti-inflammatory and laudable immunomodulatory effects in animal models of hemorrhagic shock. These animal models demonstrate decreased lung and intestinal injury after hypertonic saline resuscitation.21,22,39 Similar antiinflammatory effects are also seen in small human trials.39 In trauma patients, hypertonicsaline has the additional benefit of acting as an osmotic agent to decrease cerebral edema in patients with TBI.40,41 Because hypertonic solutions are retained more in the intravascular space, they have the potential to decrease risks of ACS andARDS. Unfortunately, human clinical trials to date have not consistently found a benefit to hypertonic saline over isotonic fluids in the prehospital or acute resuscitation phase after traumatic injury.42–45 Although an analysis of blunt trauma patients receiving hypertonic saline in conjunction withMTshowed an improvement in ARDS-free survival(HR, 2.18; CI, 1.09–4.36),42 a larger follow-up multicenter randomized controlled trial in trauma patients with hypovolemic shock found no survival or morbidity benefit compared with normal saline.43 Subgroup analysis also revealed significantly increased mortality among the subset of patients who did not require a blood transfusion in the first 24 hours.43 Additional studies of trauma patients with TBI also failed to demonstrate any improvement in mortality or neurologic outcomes
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