Efficacy of hypertonic saline dextran fluid resuscitation for patients with hypotension from penetrating trauma.
BACKGROUND
The purpose of this study was to assess whether the administration of hypertonic saline dextran (HSD) was detrimental when administered to patients who were hypotensive because of penetrating injuries to the torso. The administration of HSD causes an immediate and sustained increase in blood pressure that could contribute to an increase in bleeding in the presence of uncontrolled hemorrhage. We prospectively designed a series of questions to be addressed by a meta-analysis of individual patient data using a computerized data file and case report forms from a multicenter study of HSD.


METHODS
The investigators were "blind" as to the treatment the patient received. Patients (n = 230) with penetrating injuries to the torso were studied as to survival until discharge. The patients were administered 250 mL of HSD or normal saline (standard of care [SOC]) as the initial fluid therapy.


RESULTS
Of the 120 patients treated with HSD, 82.5% survived compared with 75.5% for 110 SOC patients (p = 0.19). Sixty-eight percent (n = 157) of these patients required surgery. HSD treatment (n = 84) in this population improved survival, 84.5% compared with 67.1% with SOC (n = 73) (p = 0.01). HSD resulted in an increase in blood pressure and a reduction in hematocrit, with no differences noted in fluid requirements or indices of clotting.


CONCLUSIONS
For patients with penetrating injuries to the torso that result in hypotension, initial fluid resuscitation with HSD is beneficial in improving survival, especially if surgery is subsequently required.
Wade
Charles E
CE
BioPhausia AB, Uppsala, Sweden. edawc@aol.com
Grady
J J
JJ
Kramer
George C
GC
D000328:Adult; D003911:Dextrans / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use*; D005260:Female; D005440:Fluid Therapy / Q000009:adverse effects*; D006470:Hemorrhage / Q000139:chemically induced* / Q000401:mortality; D006801:Humans; D007022:Hypotension / Q000188:drug therapy* / Q000209:etiology* / Q000401:mortality; D007262:Infusions, Intravenous; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010952:Plasma Substitutes / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use*; D012151:Resuscitation / Q000009:adverse effects*; D012462:Saline Solution, Hypertonic / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use*; D015996:Survival Rate; D014950:Wounds, Penetrating / Q000150:complications* / Q000188:drug therapy* / Q000401:mortality
D003911:Dextrans; D010952:Plasma Substitutes; D012462:Saline Solution, Hypertonic