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Use of hypertonic saline injection in trauma
- Source :
- American Journal of Health-System Pharmacy. 67:1920-1928
- Publication Year :
- 2010
- Publisher :
- Oxford University Press (OUP), 2010.
-
Abstract
- Purpose The use of hypertonic saline injection in trauma patients is discussed. Summary Patients with hemorrhage, burns, and traumatic brain injury (TBI) may develop hypovolemic shock and require resuscitation. Compared with conventional isotonic crystalloids, hypertonic saline has several advantages, including hemodynamic, immune-modulating, and antiinflammatory effects, for use in trauma patients for resuscitation. In addition, hypertonic saline is also used in patients with TBI to reduce intracranial pressure (ICP). Overall, studies have not shown a difference in mortality or other clinically important outcomes with the use of hypertonic saline for resuscitation in trauma patients; however, most of these studies were not adequately powered to show significant differences. A recent Cochrane review concluded that there is no evidence that hypertonic crystalloids are better than isotonic or near-isotonic crystalloids for fluid resuscitation in trauma patients. Two recent trials that were adequately powered to investigate a mortality endpoint were halted for futility. A few small randomized controlled studies found that hypertonic saline was more effective than mannitol as a hyperosmolar agent for ICP reduction. Recent guidelines from the American Burn Association have suggested that hypertonic saline may be used for burn shock resuscitation by experienced providers with close monitoring to avoid excessive hypernatremia. One of the main concerns with the use of hypertonic saline is its potential to cause central pontine myelinolysis due to a rapid increase in serum sodium levels. Conclusion There is no evidence that hypertonic saline provides any additional benefit over isotonic crystalloid solutions for trauma resuscitation. Hypertonic saline may be more effective than mannitol at reducing ICP in patients with TBI.
- Subjects :
- Resuscitation
medicine.medical_specialty
Traumatic brain injury
Hemorrhage
medicine
Animals
Humans
Mannitol
Intracranial pressure
Saline Solution, Hypertonic
Pharmacology
business.industry
Health Policy
Shock
Crystalloid Solutions
medicine.disease
Hypertonic saline
Surgery
Brain Injuries
Anesthesia
Shock (circulatory)
Practice Guidelines as Topic
Central pontine myelinolysis
Tonicity
Hypernatremia
Isotonic Solutions
medicine.symptom
Burns
business
Subjects
Details
- ISSN :
- 15352900 and 10792082
- Volume :
- 67
- Database :
- OpenAIRE
- Journal :
- American Journal of Health-System Pharmacy
- Accession number :
- edsair.doi.dedup.....e55f0b4c8ef39b616c83a55de110f416