Effects of hypertonic saline on the development of acute lung injury following traumatic shock

摘要

Hypertonic saline (HS) is a promising fluid resuscitation therapy with the potential to reduce lung injury caused by severe trauma. The experimental evidence that HS has hemodynamic, anti-inflammatory, immunological, and neuroprotective properties and that it attenuates post-traumatic lung injury and multiple organ dysfunction syndrome (MODS) is undeniable. Laboratory evidence continues to accumulate to suggest that administration of HS affects cells, organs, and the neuro-humoral response to trauma, which affects both the innate and adaptive immunity. In contrast to the experimental findings, no clinical study to date has demonstrated that resuscitation of trauma patients with HS significantly reduces lung injury and MODS. Two recent clinical trials have confirmed that HS exerts similar hemodynamic, anti-inflammatory, and immunological effects as in experimental models. While it is possible that in humans such effects do not result in attenuation of post-traumatic lung injury and MODS, another explanation could be that no clinical study to date was powered to identify such clinical outcomes. An ongoing large, multicenter, randomized clinical trial across the USA and Canada is the first that is powered to determine whether resuscitation with a single dose of HS reduces post-traumatic lung dysfunction and consequently should become part of the resuscitation of severely traumatized patients.