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Efficacy and safety of hypertonic saline solutions fluid resuscitation on hypovolemic shock: A systematic review and meta-analysis of randomized controlled trials

Kamil Safiejko, Jacek Smereka, Michal Pruc, Jerzy R. Ladny, Milosz J. Jaguszewski, Krzysztof J. Filipiak, Ruslan Yakubtsevich, Lukasz Szarpak
DOI: 10.5603/CJ.a2020.0134
·
Pubmed: 33140397

open access

Ahead of print
Original articles
Published online: 2020-10-22

Abstract

Background: Fluid resuscitation is a fundamental intervention in patients with hypovolemic shock resulting from trauma. Appropriate fluid resuscitation in trauma patients could reduce organ failure, until blood components are available, and hemorrhage is controlled. We conducted a systematic review and meta-analysis assessing the effect of hypertonic saline/dextran or hypertonic saline for fluid resuscitation on patient outcomes restricted to adults with hypovolemic shock.

Methods: We conducted a search of electronic information sources, including PubMed, Embase, Web of Science, Cochrane library and bibliographic reference lists to identify all randomized controlled trials (RCTs) investigating outcomes of crystalloids versus colloids in patients with hypovolemic shock. We calculated the risk ratio (RR) or mean difference (MD) of groups using fixed or random-effect models.

Results: Fifteen studies including 3264 patients met our inclusion criteria. Survival to hospital discharge rate between research groups varied and amounted to 71.2% in hypertonic saline/dextran group vs. 68.4% for isotonic/normotonic fluid (NS) solutions (odds ratio [OR] = 1.19; 95% confidence interval [CI] 0.97–1.45; I2 = 48%; p = 0.09). 28- to 30-days survival rate for hypertonic fluid solutions was 72.8% survivable, while in the case of isotonic fluid (NS) — 71.4% (OR = 1.13; 95% CI 0.75–1.70; I2 = 43%; p = 0.56).

Conclusions: This systematic review and meta-analysis, which included only evidence from RCTs hypertonic saline/dextran or hypertonic saline compared with isotonic fluid did not result in superior 28- to 30-day survival as well as in survival to hospital discharge. However, patients with hypotension who received resuscitation with hypertonic saline/dextran had less overall mortality as patients who received conventional fluid.

Abstract

Background: Fluid resuscitation is a fundamental intervention in patients with hypovolemic shock resulting from trauma. Appropriate fluid resuscitation in trauma patients could reduce organ failure, until blood components are available, and hemorrhage is controlled. We conducted a systematic review and meta-analysis assessing the effect of hypertonic saline/dextran or hypertonic saline for fluid resuscitation on patient outcomes restricted to adults with hypovolemic shock.

Methods: We conducted a search of electronic information sources, including PubMed, Embase, Web of Science, Cochrane library and bibliographic reference lists to identify all randomized controlled trials (RCTs) investigating outcomes of crystalloids versus colloids in patients with hypovolemic shock. We calculated the risk ratio (RR) or mean difference (MD) of groups using fixed or random-effect models.

Results: Fifteen studies including 3264 patients met our inclusion criteria. Survival to hospital discharge rate between research groups varied and amounted to 71.2% in hypertonic saline/dextran group vs. 68.4% for isotonic/normotonic fluid (NS) solutions (odds ratio [OR] = 1.19; 95% confidence interval [CI] 0.97–1.45; I2 = 48%; p = 0.09). 28- to 30-days survival rate for hypertonic fluid solutions was 72.8% survivable, while in the case of isotonic fluid (NS) — 71.4% (OR = 1.13; 95% CI 0.75–1.70; I2 = 43%; p = 0.56).

Conclusions: This systematic review and meta-analysis, which included only evidence from RCTs hypertonic saline/dextran or hypertonic saline compared with isotonic fluid did not result in superior 28- to 30-day survival as well as in survival to hospital discharge. However, patients with hypotension who received resuscitation with hypertonic saline/dextran had less overall mortality as patients who received conventional fluid.

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Keywords

fluid resuscitation, hypovolemic shock, trauma, injury, hypertonic saline, normal saline, treatment, crystalloid, colloid fluid

Supplementary Files (1)
Supplementary Digital File 1. (1) Characteristics of included studies including inclusion and exclusion criteria; (2) Adverse events while using hypertonic saline/dextran solutions versus isotonic fluid solutions; (3) Adverse events while using hypertoni
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Title

Efficacy and safety of hypertonic saline solutions fluid resuscitation on hypovolemic shock: A systematic review and meta-analysis of randomized controlled trials

Journal

Cardiology Journal

Issue

Ahead of print

Article type

Research paper

Published online

2020-10-22

DOI

10.5603/CJ.a2020.0134

Pubmed

33140397

Keywords

fluid resuscitation
hypovolemic shock
trauma
injury
hypertonic saline
normal saline
treatment
crystalloid
colloid fluid

Authors

Kamil Safiejko
Jacek Smereka
Michal Pruc
Jerzy R. Ladny
Milosz J. Jaguszewski
Krzysztof J. Filipiak
Ruslan Yakubtsevich
Lukasz Szarpak

References (34)
  1. Kelley DM. Hypovolemic shock: an overview. Crit Care Nurs Q. 2005; 28(1): 2–19; quiz 20.
  2. Kobayashi L, Costantini TW, Coimbra R. Hypovolemic shock resuscitation. Surg Clin North Am. 2012; 92(6): 1403–1423.
  3. Dolanbay T, Aksoy N, Gul H, et al. Evaluation of paediatric blunt abdomen trauma patients presenting to the emergency room. Disaster Emerg Med J. 2020; 5(1): 19–23.
  4. Annane D, Siami S, Jaber S, et al. Effects of fluid resuscitation with colloids vs crystalloids on mortality in critically ill patients presenting with hypovolemic shock: the CRISTAL randomized trial. JAMA. 2013; 310(17): 1809–1817.
  5. Galvagno SM, Nahmias JT, Young DA. Advanced trauma life support update 2019: management and applications for adults and special populations. Anesthesiol Clin. 2019; 37(1): 13–32.
  6. Simma B, Burger R, Falk M, et al. A prospective, randomized, and controlled study of fluid management in children with severe head injury: lactated Ringer's solution versus hypertonic saline. Crit Care Med. 1998; 26(7): 1265–1270.
  7. Maguigan KL, Dennis BM, Hamblin SE, et al. Method of hypertonic saline administration: effects on osmolality in traumatic brain injury patients. J Clin Neurosci. 2017; 39: 147–150.
  8. Reddy S, Weinberg L, Young P. Crystalloid fluid therapy. Crit Care. 2016; 20: 59.
  9. Martin GS, Bassett P. Crystalloids vs. colloids for fluid resuscitation in the Intensive Care Unit: A systematic review and meta-analysis. J Crit Care. 2019; 50: 144–154.
  10. Safiejko K, Smereka J, Filipiak KJ, et al. Effectiveness and safety of hypotension fluid resuscitation in traumatic hemorrhagic shock: a systematic review and meta-analysis of randomized controlled trials. Cardiol J. 2020 [Epub ahead of print].
  11. Hutton B, Salanti G, Caldwell DM, et al. The PRISMA extension statement for reporting of systematic reviews incorporating network meta-analyses of health care interventions: checklist and explanations. Ann Intern Med. 2015; 162(11): 777–784.
  12. Higgins J, Green S, (editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0. The Cochrane Collaboration 2011. www.cochrane-handbook.org (updated March 2011).
  13. Hozo SP, Djulbegovic B, Hozo I. Estimating the mean and variance from the median, range, and the size of a sample. BMC Med Res Methodol. 2005; 5: 13.
  14. Alpar EK, Killampalli VV. Effects of hypertonic dextran in hypovolaemic shock: a prospective clinical trial. Injury. 2004; 35(5): 500–506.
  15. Bulger EM, Jurkovich GJ, Nathens AB, et al. Hypertonic resuscitation of hypovolemic shock after blunt trauma: a randomized controlled trial. Arch Surg. 2008; 143(2): 139–48; discussion 149.
  16. Bulger EM, May S, Kerby JD, et al. Out-of-hospital hypertonic resuscitation after traumatic hypovolemic shock: a randomized, placebo controlled trial. Ann Surg. 2011; 253(3): 431–441.
  17. 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. 2004; 291(11): 1350–1357.
  18. Holcroft JW, Vassar MJ, Turner JE, et al. 3% NaCl and 7.5% NaCl/dextran 70 in the resuscitation of severely injured patients. Ann Surg. 1987; 206(3): 279–288.
  19. Holcroft JW, Vassar MJ, Perry CA, et al. Use of a 7.5% NaCl/6% Dextran 70 solution in the resuscitation of injured patients in the emergency room. Prog Clin Biol Res. 1989; 299: 331–338.
  20. Mattox KL, Maningas PA, Moore EE, et al. Prehospital hypertonic saline/dextran infusion for post-traumatic hypotension. The U.S.A. Multicenter Trial. Ann Surg. 1991; 213(5): 482–491.
  21. Morrison LJ, Baker AJ, Rhind SG, et al. The Toronto prehospital hypertonic resuscitation--head injury and multiorgan dysfunction trial: feasibility study of a randomized controlled trial. J Crit Care. 2011; 26(4): 363–372.
  22. 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. Ann Surg. 2006; 243(1): 47–57.
  23. Vassar MJ, Perry CA, Gannaway WL, et al. 7.5% sodium chloride/dextran for resuscitation of trauma patients undergoing helicopter transport. Arch Surg. 1991; 126(9): 1065–1072.
  24. 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. Arch Surg. 1993; 128(9): 1003–11; discussion 1011.
  25. Vassar M, Perry C, Holcroft J. Prehospital resuscitation of hypotensive trauma patients with 7.5% NaCl versus 7.5% NaCl with added dextran: a controlled trial. JTrauma. 1993; 34(5): 622–633.
  26. Wade CE, Grady JJ, Kramer GC. Efficacy of hypertonic saline dextran fluid resuscitation for patients with hypotension from penetrating trauma. J Trauma. 2003; 54(5 Suppl): S144–S148.
  27. 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(4): 380–385.
  28. Younes RN, Birolini D. Hypertonic/hyperoncotic solution in hypovolemic patients: experience in the emergency room. Rev Hosp Clin Fac Med Sao Paulo. 2002; 57(3): 124–128.
  29. Krzych ŁJ, Czempik PF. Effect of fluid resuscitation with balanced solutions on platelets: In vitro simulation of 20% volume substitution. Cardiol J. 2018; 25(2): 254–259.
  30. Barker ME. 0.9% saline induced hyperchloremic acidosis. J Trauma Nurs. 2015; 22(2): 111–116.
  31. Kiraly LN, Differding JA, Enomoto TM, et al. Resuscitation with normal saline (NS) vs. lactated ringers (LR) modulates hypercoagulability and leads to increased blood loss in an uncontrolled hemorrhagic shock swine model. J Trauma. 2006; 61(1): 57–64; discussion 64.
  32. Zitek T, Skaggs ZD, Rahbar A, et al. Does Intravenous Lactated Ringer's Solution Raise Serum Lactate? J Emerg Med. 2018; 55(3): 313–318.
  33. Stern SA, Jwayyed S, Dronen SC, et al. Resuscitation of severe uncontrolled hemorrhage: 7.5% sodium chloride/6% dextran 70 vs 0.9% sodium chloride. Acad Emerg Med. 2000; 7(8): 847–856.
  34. Søreide E, Deakin CD. Pre-hospital fluid therapy in the critically injured patient--a clinical update. Injury. 2005; 36(9): 1001–1010.

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