Clinical experience using 5% hypertonic saline as a safe alternative fluid for use in trauma.
BACKGROUND
Published experience of hypertonic saline (HTS) use in resuscitation has described the use of commercially unavailable 7.5% solutions. The purpose of this study was to compare our experience with the administration of commercially available 5% HTS solution with that of well-matched controls who did not receive HTS.


METHODS
Prospective observational study of 51 trauma patients receiving 500 mL of 5% HTS during initial resuscitation. Patients who received HTS were 1:2 matched using age, gender, Injury Severity Score, Coma Score, Head Abbreviated Injury Scale, and injury mechanism to trauma patients who did not receive HTS. The laboratory values and outcomes of the two groups were compared.


RESULTS
Patients receiving HTS demonstrated no difference from the matched cohort in mean pH, international normalized ratio, or p/f ratios at 8 hours or 24 hours. The mean serum sodium of the HTS group was higher than controls at 8 hours (143.1 vs. 150.1 mg/dL, p < 0.001) and remained significantly more increased for 3 days without any adverse sequelae related to hypernatremia. No difference in mortality was noted between the two groups. A trend in decreased mortality was observed in patients with Coma Score <or=8 and Head Abbreviated Injury Scale score >or=3 (25.0% vs. 42.5%). The mean ventilator days were 7.3 for HTS group and 9.2 for the non-HTS group.


CONCLUSIONS
Although serum sodium remained increased for several days after HTS administration, no adverse sequelae as a result of hypernatremia resulted. Commercially available 5% HTS solution is safe for use in the resuscitation of trauma patients and may improve outcomes in a selected subset of patients with head injury.
DuBose
Joseph J
JJ
Division of Trauma, University of Southern California Medical Center, Los Angeles County, Los Angeles, California, USA.
Kobayashi
Leslie
L
Lozornio
Alfredo
A
Teixeira
Pedro
P
Inaba
Kenji
K
Lam
Lydia
L
Talving
Peep
P
Branco
Bernardino
B
Demetriades
Demetrios
D
Rhee
Peter
P
D015998:Abbreviated Injury Scale; D000293:Adolescent; D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D016009:Chi-Square Distribution; D005260:Female; D005440:Fluid Therapy / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D006955:Hypernatremia / Q000097:blood / Q000139:chemically induced; D015601:Injury Severity Score; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012121:Respiration, Artificial / Q000706:statistics & numerical data; D012151:Resuscitation / Q000009:adverse effects / Q000379:methods*; D012449:Safety; D012462:Saline Solution, Hypertonic / Q000009:adverse effects / Q000627:therapeutic use*; D012964:Sodium / Q000097:blood; D014194:Traumatology / Q000379:methods*; D016896:Treatment Outcome; D014947:Wounds and Injuries / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000628:therapy*
D012462:Saline Solution, Hypertonic; D012964:Sodium