[Hypertonic solutions for pediatric patients].
OBJECTIVE
To describe the current knowledge and indications for use of hypertonic saline solutions in pediatrics patients.


METHODS
Medline recent review articles and personal files.


RESULTS
Basic physiologic principles were reviewed concerning the distribution of fluid inside the intravascular, interstitial and intracellular compartments. We also reviewed the findings concerning the mechanisms responsible for the rapid onset of cardiocirculatory effects and the additional effect of the colloid component. Finally, we present the medical terms used in the context of small-volume resuscitation, the indications for clinical use, the evidence from clinical research (hemorrhagic shock, preclinical trauma care, septic shock, and head trauma), and the disadvantages and potential adverse effects of small-volume resuscitation.


CONCLUSIONS
Resuscitation by means of hypertonic saline solutions associated or not with colloid solutions is one of the most innovative concepts for primary resuscitation from trauma and shock established in the past decade. Currently, the spectrum of potential indications involves not only prehospital trauma care, but also perioperative and intensive care therapy. However, additional randomized double-blind studies are required with both children and adult patients to confirm the advantages of the method in terms of survival.
de Carvalho
Werther Brunow
WB
Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil. wertherbru.dped@epm.br
D002648:Child; D003102:Colloids / Q000627:therapeutic use; D005440:Fluid Therapy / Q000379:methods*; D006801:Humans; D009104:Multiple Trauma / Q000628:therapy*; D012151:Resuscitation / Q000379:methods*; D012462:Saline Solution, Hypertonic / Q000627:therapeutic use*; D012769:Shock / Q000628:therapy*; D014882:Water-Electrolyte Balance / Q000187:drug effects
D003102:Colloids; D012462:Saline Solution, Hypertonic