Clinical Review: Hypertonic Saline Resuscitation in Sepsis

Overview

Journal Crit Care

Specialty Critical Care

Date 2002 Oct 26

PMID 12398781

Citations 29

Authors

Roselaine P Oliveira

Irineu Velasco

Francisco Garcia Soriano

Gilberto Friedman

Affiliations

Soon will be listed here.

Abstract

The present review discusses the hemodynamic effects of hypertonic saline in experimental shock and in patients with sepsis. We comment on the mechanisms of action of hypertonic saline, calling upon data in hemorrhagic and septic shock. Specific actions of hypertonic saline in severe sepsis and septic shock are highlighted. Data are available that support potential benefits of hypertonic saline infusion in various aspects of the pathophysiology of sepsis, including tissue hypoperfusion, decreased oxygen consumption, endothelial dysfunction, cardiac depression, and the presence of a broad array of proinflammatory cytokines and various oxidant species. The goal of research in this field is to identify reliable therapies to prevent ischemia and inflammation, and to reduce mortality.

Citing Articles

Reviving the Critically Ill: Exploring Effective Fluid Resuscitation Approaches for Diverse Hypovolemic Shock Cases-A Systematic Review and Meta-Analysis.

Shaban E, Elgassim M, Shaban A, Shaban A, Ahmed A, Abdelraman A Bull Emerg Trauma. 2024; 12(4):149-161.

PMID: 39697380 PMC: 11651241. DOI: 10.30476/beat.2024.102206.1505.

Hypertonic Saline Induces Host Protective Immune Responses against Infection in Mice.

Huy T, Nguyen T, Salad S, Aguilar C, Reyes A, Arayan L J Microbiol Biotechnol. 2024; 34(11):2192-2200.

PMID: 39403730 PMC: 11637827. DOI: 10.4014/jmb.2407.07040.

European Society of Intensive Care Medicine clinical practice guideline on fluid therapy in adult critically ill patients. Part 1: the choice of resuscitation fluids.

Arabi Y, Belley-Cote E, Carsetti A, De Backer D, Donadello K, Juffermans N Intensive Care Med. 2024; 50(6):813-831.

PMID: 38771364 DOI: 10.1007/s00134-024-07369-9.

Intravenous fluid therapy in sepsis.

Seitz K, Qian E, Semler M Nutr Clin Pract. 2022; 37(5):990-1003.

PMID: 35801708 PMC: 9463107. DOI: 10.1002/ncp.10892.

Hypertonic Saline in the Treatment of Hemorrhagic Shock.

Vahidi E, Naderpour Z, Saeedi M Adv J Emerg Med. 2019; 1(1):e8.

PMID: 31172060 PMC: 6548092. DOI: 10.22114/AJEM.v1i1.2.

References

Botha A, Moore F, Moore E, Sauaia A, Banerjee A, Peterson V . Early neutrophil sequestration after injury: a pathogenic mechanism for multiple organ failure. J Trauma. 1995; 39(3):411-7. DOI: 10.1097/00005373-199509000-00003. View

Mouren S, Delayance S, Mion G, Souktani R, Fellahi J, Arthaud M . Mechanisms of increased myocardial contractility with hypertonic saline solutions in isolated blood-perfused rabbit hearts. Anesth Analg. 1995; 81(4):777-82. DOI: 10.1097/00000539-199510000-00021. View

Hannemann L, Reinhart K, Korell R, Spies C, Bredle D . Hypertonic saline in stabilized hyperdynamic sepsis. Shock. 1996; 5(2):130-4. DOI: 10.1097/00024382-199602000-00008. View

Kien N, Antognini J, Reilly D, Moore P . Small-volume resuscitation using hypertonic saline improves organ perfusion in burned rats. Anesth Analg. 1996; 83(4):782-8. DOI: 10.1097/00000539-199610000-00022. View

Coimbra R, Junger W, Hoyt D, Liu F, Loomis W, Evers M . Hypertonic saline resuscitation restores hemorrhage-induced immunosuppression by decreasing prostaglandin E2 and interleukin-4 production. J Surg Res. 1996; 64(2):203-9. DOI: 10.1006/jsre.1996.0329. View

Junger W, Hoyt D, Hamreus M, Liu F, Junger W, Altman A . Hypertonic saline activates protein tyrosine kinases and mitogen-activated protein kinase p38 in T-cells. J Trauma. 1997; 42(3):437-43; discussion 443-5. DOI: 10.1097/00005373-199703000-00011. View

Coimbra R, Hoyt D, Junger W, Angle N, Wolf P, Loomis W . Hypertonic saline resuscitation decreases susceptibility to sepsis after hemorrhagic shock. J Trauma. 1997; 42(4):602-6; discussion 606-7. DOI: 10.1097/00005373-199704000-00004. View

Junger W, Coimbra R, Liu F, Junger W, Junger H, Loomis W . Hypertonic saline resuscitation: a tool to modulate immune function in trauma patients?. Shock. 1997; 8(4):235-41. View

Maciel F, Mook M, Zhang H, Vincent J . Comparison of hypertonic with isotonic saline hydroxyethyl starch solution on oxygen extraction capabilities during endotoxic shock. Shock. 1998; 9(1):33-9. DOI: 10.1097/00024382-199801000-00005. View

10.

Angle N, Hoyt D, Coimbra R, Liu F, Loomis W, Junger W . Hypertonic saline resuscitation diminishes lung injury by suppressing neutrophil activation after hemorrhagic shock. Shock. 1998; 9(3):164-70. DOI: 10.1097/00024382-199803000-00002. View

11.

Thiel M, Buessecker F, Eberhardt K, Chouker A, Setzer F, Kreimeier U . Effects of hypertonic saline on expression of human polymorphonuclear leukocyte adhesion molecules. J Leukoc Biol. 2001; 70(2):261-73. View

12.

Loomis W, Namiki S, Hoyt D, Junger W . Hypertonicity rescues T cells from suppression by trauma-induced anti-inflammatory mediators. Am J Physiol Cell Physiol. 2001; 281(3):C840-8. DOI: 10.1152/ajpcell.2001.281.3.C840. View

13.

Ciesla D, Moore E, Biffl W, Gonzalez R, Moore H, Silliman C . Hypertonic saline activation of p38 MAPK primes the PMN respiratory burst. Shock. 2001; 16(4):285-9. DOI: 10.1097/00024382-200116040-00009. View

14.

Rivers E, Nguyen B, Havstad S, Ressler J, Muzzin A, Knoblich B . Early goal-directed therapy in the treatment of severe sepsis and septic shock. N Engl J Med. 2002; 345(19):1368-77. DOI: 10.1056/NEJMoa010307. View

15.

Wildenthal K, Skelton C, Coleman 3rd H . Cardiac muscle mechanics in hyperosmotic solutions. Am J Physiol. 1969; 217(1):302-6. DOI: 10.1152/ajplegacy.1969.217.1.302. View

16.

Velasco I, Pontieri V, ROCHA E SILVA Jr M, Lopes O . Hyperosmotic NaCl and severe hemorrhagic shock. Am J Physiol. 1980; 239(5):H664-73. DOI: 10.1152/ajpheart.1980.239.5.H664. View

17.

Lopes O, Pontieri V, ROCHA E SILVA Jr M, Velasco I . Hyperosmotic NaCl and severe hemorrhagic shock: role of the innervated lung. Am J Physiol. 1981; 241(6):H883-90. DOI: 10.1152/ajpheart.1981.241.6.H883. View

18.

Nakayama S, Kramer G, Carlsen R, Holcroft J . Infusion of very hypertonic saline to bled rats: membrane potentials and fluid shifts. J Surg Res. 1985; 38(2):180-6. DOI: 10.1016/0022-4804(85)90025-3. View

19.

Younes R, Aun F, Tomida R, Birolini D . The role of lung innervation in the hemodynamic response to hypertonic sodium chloride solutions in hemorrhagic shock. Surgery. 1985; 98(5):900-6. View

20.

Rocha-E-Silva M, Negraes G, Soares A, Pontieri V, Loppnow L . Hypertonic resuscitation from severe hemorrhagic shock: patterns of regional circulation. Circ Shock. 1986; 19(2):165-75. View