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Hypertonic Resuscitation of Hypovolemic Shock After Blunt Trauma—Invited Critique
David B. Hoyt, MD
Arch Surg. 2008;143(2):149.
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Traditionally we have thought of fluid resuscitation being aimed at restoring intravascular volume and repletion of the "third-space" fluid shifts that occur after shock or trauma. The colloid-crystalloid debate over the past 30 years has focused on these end points in determining which fluid type is better. While these arguments are relevant immediately after injury when death is due to exsanguination, more recent data have shifted our focus to using early fluid resuscitation as a way to modify the inflammatory response that leads to multiple organ failure and late death.
The interest in hypertonic fluids was renewed when experimental observations 10 years ago showed that hypertonic saline (HTS) can affect the immune response. Specifically, HTS can down-regulate the expression of polymorphonuclear cell adhesion molecules, improve microvascular flow, and preserve organ function. Lactated Ringer solution has been shown to be proinflammatory and could potentially aggravate the postinjury . . . [Full Text of this Article]
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