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open access

Vol 29, No 6 (2022)
Original Article
Submitted: 2020-08-28
Accepted: 2020-09-02
Published online: 2020-10-22
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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 Safiejko1, Jacek Smereka23, Michal Pruc3, Jerzy R. Ladny34, Milosz J. Jaguszewski5, Krzysztof J. Filipiak6, Ruslan Yakubtsevich7, Lukasz Szarpak138
DOI: 10.5603/CJ.a2020.0134
·
Pubmed: 33140397
·
Cardiol J 2022;29(6):966-977.
Affiliations
  1. Maria Sklodowska-Curie Bialystok Oncology Center, Bialystok, Poland
  2. Department of Emergency Medical Ser vice, Wroclaw Medical University, Wroclaw, Poland
  3. Polish Society of Disaster Medicine, Warsaw, Poland
  4. Clinic of Emergency Medicine and Disaster, Medical University Bialystok, Poland
  5. First Department of Cardiology, Medical University of Gdansk, Poland
  6. First Chair and Depar tment of Cardiology, Medical University of Warsaw, Poland
  7. Department of Anesthesiology and Intensive Car e, Grodno State Medical Univer sity, Grodno, Belarus
  8. Maria Sklodowska-Curie Medical Academy, Warsaw, Poland

open access

Vol 29, No 6 (2022)
Original articles — Clinical cardiology
Submitted: 2020-08-28
Accepted: 2020-09-02
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 (normal saline) 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 (normal saline) — 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 (normal saline) 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 (normal saline) — 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

Supp./Additional 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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About this article
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

Vol 29, No 6 (2022)

Article type

Original Article

Pages

966-977

Published online

2020-10-22

Page views

4932

Article views/downloads

1959

DOI

10.5603/CJ.a2020.0134

Pubmed

33140397

Bibliographic record

Cardiol J 2022;29(6):966-977.

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

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