Hypertonic saline in the traumatic hypovolemic shock: meta-analysis.
BACKGROUND
A wealth of evidence from animal experiments has indicated that hypertonic saline (HS) maybe a better choice for fluid resuscitation in traumatic hypovolemic shock in comparison with conventional isotonic saline. However, the results of several clinical trials raised controversies on the superiority of fluid resuscitation with HS. This meta-analysis was performed to better understand the efficacy of HS in patients with traumatic hypovolemic shock comparing with isotonic saline.


METHODS
According to the search strategy, we searched the PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials, which was completed on October 2013. After literature searching, two investigators independently performed the literature screening, assessment of quality of the included trials, and data extraction. Disagreements were resolved by consensus or by a third investigator if needed. The outcomes included mortality, blood pressure, fluid requirement, and serum sodium.


RESULTS
Six randomized controlled trials were included in the meta-analysis. The pooled risk ratio for mortality at discharge was 0.96 (95% confidence interval [CI], 0.82-1.14), whereas the pooled mean difference for the change in systolic blood pressure from baseline and the level of serum sodium after infusion was 6.47 (95% CI, 1.31-11.63) and 7.94 (95% CI, 7.38-8.51), respectively. Current data were insufficient to evaluate the effect of HS on the fluid requirement for the resuscitation.


CONCLUSIONS
The present meta-analysis was unable to demonstrate a clinically important improvement in mortality after the HS administration. Moreover, we observed HS administration maybe accompanied with significant increase in blood pressure and serum sodium.
Department of Neurosurgery, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, P.R. China.
Jia-Wei
JW
Wang
Department of Neurosurgery, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, P.R. China.
Jin-Ping
JP
Li
Department of Neurosurgery, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, P.R. China.
Ying-lun
YL
Song
Department of Neurosurgery, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, P.R. China.
Ke
K
Tan
Department of Neurosurgery, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, P.R. China.
Yu
Y
Wang
Department of Neurosurgery, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, P.R. China.
Tao
T
Li
Department of Neurosurgery, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, P.R. China.
Peng
P
Guo
Department of Neurosurgery, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, P.R. China.
Xiong
X
Li
Department of Neurosurgery, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, P.R. China.
Yan
Y
Wang
Department of Neurosurgery, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, P.R. China. Electronic address: chaoyanghospital@126.com.
Qi-Huang
QH
Zhao
D000328:Adult; D006801:Humans; D020896:Hypovolemia / Q000097:blood / Q000188:drug therapy* / Q000503:physiopathology; D012462:Saline Solution, Hypertonic / Q000627:therapeutic use*; D012774:Shock, Traumatic / Q000097:blood / Q000188:drug therapy* / Q000503:physiopathology; D012964:Sodium / Q000097:blood; D013599:Systole / Q000187:drug effects
D012462:Saline Solution, Hypertonic; D012964:Sodium
Hypertonic saline; Meta-analysis; Randomized controlled trial; Traumatic hypovolemic shock