Silva, Mauricio Rocha e

doi:10.5935/MedicalExpress.2014.01.04

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REVIEWS • MedicalExpress (São Paulo, online) 1 (1) • Fev 2014 • https://doi.org/10.5935/MedicalExpress.2014.01.04 copiar

Hypertonic saline for treatment of shock: have we looked for everything?

Autoria SCIMAGO INSTITUTIONS RANKINGS

RESUMO

O procedimento de ressuscitação hipertônica a pequeno volume foi originalmente baseado no conceito de que uma expansão fisiologicamente significativa de volume sanguíneo resulta da administração de um pequeno volume de fluido hipertônico. A hipertonia é reconhecidamente um vasodilatador fisioló gico, de modo que seu uso após uma importante perda de sangue induz reperfusão. Pesquisas anteriormente divulgadas descrevem uma série de propriedades da solução hipertônica de NaCl, entre eles (i) a correção de endotelial e edema de células vermelhas com consequências significativas em termos de fluxo sanguíneo capilar, (ii) a modulação do sistema imunológico. Esta avaliação abrange a evolução neste campo entre 2005 e 2013. Como conclusã o, discutimos a discrepância entre achados experimentais e clínicos; argumentamos que em sua essência, são possivelmente falhos os objetivos dos ensaios clínicos multicêntricos recentemente realizados.

Author (ref)	Species	Test Agent	CTR	Target
Superiority
Coimbra⁴³43 Coimbra R, Porcides R, Loomis W, Melbostad H, Lall R, Deree J, et al. HSPTX protects against hemorrhagic shock resuscitation-induced tissue injury: an attractive alternative to Ringer's lactate. J Trauma. 2006;60(1):41-51.	rat	HS^* * : Hypertonic Saline; +PTX^‡ ‡ : Pentoxiphyline;	NS^† † : Normal saline;	Immune function
Constantini⁴⁴44 Costantini TW, Deree J, Martins JO, Putnam JG, Campos T, Coimbra R. A novel fluid resuscitation strategy modulates pulmonary transcription factor activation in a murine model of hemorrhagic shock. Clinics (Sao Paulo). 2010;65(6):621-8.	rat	HS+PTX	LR^§ § : Lactated Ringer's.	Immune function
Cruz⁴⁵45 Cruz Jr. RJ, Yada-Langui MM, de Figueiredo LF, Sinosaki S, Rocha e Silva M. The synergistic effects of pentoxifylline on systemic and regional perfusion after hemorrhage and hypertonic resuscitation. Anesth Analg. 2006;102(5):1518-24.	rat	HS+PTX	NS	Immune function
Lu²³23 Lu YQ, Cai XJ, Gu LH, Mu HZ, Huang WD. Hypertonic saline resuscitation maintains a more balanced profile of T-lymphocyte subpopulations in a rat model of hemorrhagic shock. J Zhejiang Univ Sci B. 2007;8(1):70-5.	rat	HS	NS	Immune function
Lu⁴⁶46 Lu YQ, Gu LH, Jiang JK, Mou HZ. Effect of hypertonic versus isotonic saline resuscitation on heme oxygenase-1 expression in visceral organs following hemorrhagic shock in rats. Biomed Environ Sci. 2013;26(8):684-8.	rat	HS	NS	Apoptosis; Organ damage
Hoppen⁴⁷47 Hoppen RA, Corso CO, Grezzana TJ, Severino A, Dal-Pizzol F, Ritter C. Hypertonic saline and hemorrhagic shock: hepatocellular function and integrity after six hours of treatment. Acta Cir Bras. 2005;20(6):414-7.	rat	HS	NS	Liver function
Sharma⁴⁸48 Sharma P, Benford B, Karaian JE, Keneally R. Effects of volume and composition of the resuscitative fluids in the treatment of hemorrhagic shock. J Emerg Trauma Shock. 2012;5(4):309-15.	rat	HS	LR	renal function
Equivalence
Younes⁴⁹49 Younes RN, Deutsch F, Itinoshe M, Fontes B, Poggetti R, Birolini D. Responsiveness to different volume therapies following hemodilution and hemorrhagic shock: a comparative experimental study in rats. Acta Cir Bras. 2007;22(5):355-60.	rat	HS	NS	Survival
Nascimento⁵⁰50 Nascimento Jr P, de Paiva Filho O, de Carvalho LR, Braz JR. Early hemodynamic and renal effects of hemorrhagic shock resuscitation with lactated Ringer's solution, hydroxyethyl starch, and hypertonic saline with or without 6% dextran-70. J Surg Res. 2006;136(1):98-105.	dog	HS	LR	renal function
Watters⁵¹51 Watters JM, Tieu BH, Differding JA, Muller PJ, Schreiber MA. A single bolus of 3% hypertonic saline with 6% dextran provides optimal initial resuscitation after uncontrolled hemorrhagic shock. J Trauma. 2006;61(1):75-81.	swine	HS	NS	renal function
Legrand⁵²52 Legrand M, Mik EG, Balestra GM, Lutter R, Pirracchio R, Payen D, et al. Fluid resuscitation does not improve renal oxygenation during hemorrhagic shock in rats. Anesthesiology. 2010;112(1):119-27.	rat	HS	NS	renal function
Garcia-Martinez⁵³53 Garcia-Martinez D, Portilla-de Buen E, Leal C, Santillan P, Muniz J. The immediate response to severe shock in a canine model with a combination of hypertonic-hyperoncotic solution with naloxone. Shock. 2006;26(4):379-85.	dog	HSD + naloxone	blood	Hemodynamics

Author (ref)	Species	Test Agent	CTR	Model/Target
Superiority
Shih⁵⁵55 Shih CC, Chen SJ, Chen A, Wu JY, Liaw WJ, Wu CC. Therapeutic effects of hypertonic saline on peritonitis-induced septic shock with multiple organ dysfunction syndrome in rats. Crit Care Med. 2008;36(6):1864-72.	rat	HS	LR	CLP/immune response
Shih⁵⁶56 Shih CC, Tsai MF, Chen SJ, Tsao CM, Ka SM, Huang HC, et al. Effects of small-volume hypertonic saline on acid-base and electrolytes balance in rats with peritonitis-induced sepsis. Shock. 2012;38(6):649-55.	rat	HS	LR	CLP/immune/survival
Yu⁴¹41 Yu G, Chi X, Hei Z, Shen N, Chen J, Zhang W, et al. Small volume resuscitation with 7.5% hypertonic saline, hydroxyethyl starch 130/0.4 solution and hypertonic sodium chloride hydroxyethyl starch 40 injection reduced lung injury in endotoxin shock rats: comparison with saline. Pulm Pharmacol Ther. 2012;25(1):27-32.	rat	HS or HSH	-	Endotoxin/lung injury
Somell⁵⁷57 Somell A, Weitzberg E, Suneson A, Sollevi A, Hjelmqvist H. Effects of the dual endothelin receptor antagonist tezosentan and hypertonic saline/dextran on porcine endotoxin shock. Acta Physiol (Oxf). 2007;190(4):291-302.	swine	HS + tezosentan	NS	Endotoxin/Cardiac function
Kim⁵⁸58 Kim HJ, Lee KH. The effectiveness of hypertonic saline and pentoxifylline (HTS-PTX) resuscitation in haemorrhagic shock and sepsis tissue injury: comparison with LR, HES, and LR-PTX treatments. Injury. 2012;43(8):1271-6.	rat	HS + PTX	LR	CLP/immune/lung injury
Liu⁴²42 Liu Z, Li Y, Liu B, Deperalta DK, Zhao T, Chong W, et al. Synergistic effects of hypertonic saline and valproic acid in a lethal rat two-hit model. J Trauma Acute Care Surg. 2013;74(4):991-7, discussion 7-8.	rat	HS	-	CLP/survival/lung injury
Gao⁵⁹59 Gao J, Zhao WX, Xue FS, Zhou LJ, Yu YH, Zhou HB. Effects of different resuscitation fluids on acute lung injury in a rat model of uncontrolled hemorrhagic shock and infection. J Trauma. 2009;67(6):1213-9.	rat	HS or HSS	LR	Hemorrhage + sepsis/lung
Luiz Zanoni⁶⁰60 Luiz Zanoni F, Costa Cruz JW, Martins JO, Benabou S, Vicente Greco K, Ramos Moreno AC, et al. Hypertonic saline solution reduces mesenteric microcirculatory dysfunctions and bacterial translocation in a rat model of strangulated small bowel obstruction. Shock. 2013;40(1):35-44.	rat	HS	LR	Intestinal obstruction/immune & gut damage
Equivalence
Wan⁶¹61 Wan L, Bellomo R, May CN. Bolus hypertonic or normal saline resuscitation in gram-negative sepsis: systemic and regional haemodynamic effects in sheep. Crit Care Resusc. 2011;13(4):262-70.	sheep	HS	NS	Gram-negative sepsis/renal function

Author (ref)	patients	Test Agent	CTR	Model/Target
Superiority
Rizoli⁶²62 Rizoli SB, Rhind SG, Shek PN, Inaba K, Filips D, Tien H, 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.	27	HSD	NS	Hemorrhage/immune response
Junger⁶³63 Junger WG, Rhind SG, Rizoli SB, Cuschieri J, Shiu MY, Baker AJ, et al. Resuscitation of traumatic hemorrhagic shock patients with hypertonic saline-without dextran-inhibits neutrophil and endothelial cell activation. Shock. 2012;38(4):341-50.	34	HS/HSD	NS	Hemorrhage/immune response
Bulger⁶⁴64 Bulger EM, Cuschieri J, Warner K, Maier RV. Hypertonic resuscitation modulates the inflammatory response in patients with traumatic hemorrhagic shock. Ann Surg. 2007;245(4):635-41.	62	HSD	NS	Hemorrhage/immune response
Yildizdas⁶⁵65 Yildizdas D, Altunbasak S, Celik U, Herguner O. Hypertonic saline treatment in children with cerebral edema. Indian Pediatr. 2006;43(9):771-9.	67	HS	mannitol	pediatric cerebral edema/intracranial pressure
Schroth⁶⁶66 Schroth M, Plank C, Meissner U, Eberle KP, Weyand M, Cesnjevar R, et al. Hypertonic-hyperoncotic solutions improve cardiac function in children after open-heart surgery. Pediatrics. 2006;118(1):e76-84.	50	HSH	NS	pediatric open heart surgery
Equivalence
Bulger⁶⁷67 Bulger EM, Jurkovich GJ, Nathens AB, Copass MK, Hanson S, Cooper C, et al. Hypertonic resuscitation of hypovolemic shock after blunt trauma: a randomized controlled trial. Arch Surg. 2008;143(2):139-48,	209	HSD	LR	Blunt trauma & hypotension/ARDSfree at 28 days
Bulger⁶⁸68 Bulger EM, May S, Brasel KJ, Schreiber M, Kerby JD, Tisherman SA, et al. Out-of-hospital hypertonic resuscitation following severe traumatic brain injury: a randomized controlled trial. JAMA. 2010;304(13):1455-64.	1331	HS/HSD	NS	Head Injury/Brain deficit at 6 months
Bulger⁶⁹69 Bulger EM, May S, Kerby JD, Emerson S, Stiell IG, Schreiber MA, et al. Out-of-hospital hypertonic resuscitation after traumatic hypovolemic shock: a randomized, placebo controlled trial. Ann Surg. 2011;253(3):431-41.	853	HS/HSD	NS	Hemorrhage/Survival at 28 days
Fang⁷⁰70 Fang ZX, Li YF, Zhou XQ, Zhang Z, Zhang JS, Xia HM, et al. Effects of resuscitation with crystalloid fluids on cardiac function in patients with severe sepsis. BMC Infect Dis. 2008;8:50.	94	HS/HCO₃	NS	Sepsis & Hypotension/Survival

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[1] E-mail: mauricio.silva@pobox.com