Hypertonic solutions: when, how, how long, how much?

摘要

The current interest for the use of hypertonic solutions was triggered by our institution in 1980. It was shown that a bolus injections of 7.5% NaCl, 4 ml/kg, a volume equivalent to only 10% of the volume of shed blood, rapidly restored arterial pressure and cardiac output in a severely hemorrhaged dog, resulting in long-term survival. Control animals, which received the same volume of isotonic saline, did not respond with hemodynamic improvement or survival. Human use of 7.5% NaCl solutions began with Fellipe et al. , treating patients with refractory shock in a critical care unit and showing hemodynamic benefits. Both studies were the basis for hundreds of subsequent experimental studies and more than 60 clinical trials with 7.5% NaCl in the treatment of several conditions, such as hemorrhagic, cardiogenic, and septic shock, as well as a volume-supporting solution during major surgical procedural studies. We address the questions regarding when, how, how long, and how much based on the available clinical data for efficacy and safety in several emergency and elective conditions.