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Revista Brasileira de Terapia Intensiva

Print version ISSN 0103-507X

Rev. bras. ter. intensiva vol.24 no.4 São Paulo Oct./Dec. 2012 



How do you prefer your resuscitation solution? Do you want a little bit more salt?



Felipe Dal-PizzolI; Mervyn SingerII

IExperimental Pathophysiology Laboratory and National Institute of Medical Translational Science and Technology, Health Sciences Postgraduate Program, Health Sciences Unit, Universidade do Extremo Sul Catarinense - Criciúma (SC), Brazil
IIBloomsbury Institute of Intensive Care Medicine, University College London - UCL - London, England

Corresponding author



In this issue of the Revista Brasileira de Terapia Intensiva, Rios et al.(1) demonstrate the effects of volume replacement with hypertonic saline solution (HSS) on hepatic cytokine production and expression of heat-shock proteins and apoptotic proteins in an animal model of acute pancreatitis. HSS down-regulated liver cytokine production and HSP60 expression in a more robust manner when compared to normal saline solution.

More than 30 years have passed since the first description of HSS as a resuscitation solution in hemorrhagic shock.(2) HSS can exert its beneficial effects by mobilizing fluids from intracellular to extracellular compartments and by improving myocardial contractility and microcirculatory flow.(3) In addition, it may have immunomodulatory effects.(3) Thus, the original rationale based on its osmotic effect that enables small volume resuscitation in hypovolemic shock(2) and decreases brain edema after traumatic brain injury(4) may be too simplistic. The results presented by Rios et al.(1) add to previous demonstrations of benefit from HSS on several different aspects of inflammation and organ function in pre-clinical models of systemic inflammatory response syndrome (SIRS) and sepsis.(3) However, human trials have failed to provide convincing evidence of efficacy.(5) Clearly this potential needs to be examined further, particularly as it is cheap and widely available, but we should wait until more robust clinical data are available.



1. Rios EC, Moretti AI, Souza HP, Velasco IT, Soriano FG. Reposição volêmica com soluções Salinas em pancreatite e perfil hepático de proteínas apoptóticas e de choque térmico. Rev Bras Ter Intensiva. 2012;24(4):326-33.         [ Links ]

2. Velasco IT, Pontieri V, Rocha e Silva M Jr, Lopes OU. Hyperosmotic NaCl and severe hemorrhagic shock. Am J Physiol. 1980;239(5):H664-73.         [ Links ]

3. Oliveira RP, Velasco I, Soriano FG, Friedman G. Clinical review: Hypertonic saline resuscitation in sepsis. Crit Care. 2002;6(5):418-23.         [ Links ]

4. Ropper AH. Hyperosmolar therapy for raised intracranial pressure. N Engl J Med. 2012;367(8):746-52.         [ Links ]

5. Strandvik GF. Hypertonic saline in critical care: a review of the literature and guidelines for use in hypotensive states and raised intracranial pressure. Anaesthesia. 2009;64(9):990-1003.         [ Links ]



Corresponding author:
Felipe Dal-Pizzol
Laboratório de Fisiopatologia Experimental and Instituto Nacional de Ciência e Tecnologia Translacional em Medicina
Programa de Pós-Graduação em Ciências da Saúde
Unidade Acadêmica de Ciências da Saúde
Universidade do Extremo Sul Catarinense
Avenida Universitária, 1105
Zip Code: 88806-000 - Criciúma (SC), Brazil

Conflict of interest: None

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