title: Immunomodulatory effect of hypertonic saline in hemorrhagic shock.
abstract: Multiple organ dysfunction syndrome (MODS) and nosocomial infection following trauma-hemorrhage are among the most important causes of mortality in hemorrhagic shock patients. Dysregulation of the immune system plays a central role in MODS and a fluid having an immunomodulatory effect could be advantageous in hemorrhagic shock resuscitation. Hypertonic saline (HS) is widely used as a resuscitation fluid in trauma-hemorrhagic patients. Besides having beneficial effects on the hemodynamic parameters, HS has modulatory effects on various functions of immune cells such as degranulation, adhesion molecules and cytokines expression, as well as reactive oxygen species production. This article reviews clinical evidence for decreased organ failure and mortality in hemorrhagic shock patients resuscitated with HS. Despite promising results in animal models, results from pre-hospital and emergency department administration in human studies did not show improvement in survival, organ failure, or a reduction in nosocomial infection by HS resuscitation. Further post hoc analysis showed some benefit from HS resuscitation for severely-injured patients, those who received more than ten units of blood by transfusion, patients who underwent surgery, and victims of traumatic brain injury. Several reasons are suggested to explain the differences between clinical and animal models.
authors.affiliation: Department of Pharmacotherapy, Faculty of Pharmacy, Tehran University of Medical Sciences, 16 Azar Ave, Enghelab Sq, Tehran, Iran. motahariniaj@gmail.com.
authors.forename: Javad
authors.initials: J
authors.lastname: Motaharinia
authors.affiliation: Department of Anesthesiology & Critical Care, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran. etezadi@sina.tums.ac.ir.
authors.forename: Farhad
authors.initials: F
authors.lastname: Etezadi
authors.affiliation: Department of Pharmacotherapy, Faculty of Pharmacy, Tehran University of Medical Sciences, 16 Azar Ave, Enghelab Sq, Tehran, Iran. zadeh-moghaddas@yahoo.com.
authors.forename: Azadeh
authors.initials: A
authors.lastname: Moghaddas
authors.affiliation: Department of Pharmacotherapy, Faculty of Pharmacy, Tehran University of Medical Sciences, 16 Azar Ave, Enghelab Sq, Tehran, Iran. mojtahed@tums.ac.ir.
authors.forename: Mojtaba
authors.initials: M
authors.lastname: Mojtahedzadeh
mesh_terms: D000818:Animals; D003428:Cross Infection / Q000453:epidemiology* / Q000276:immunology; D006801:Humans; D009102:Multiple Organ Failure / Q000453:epidemiology* / Q000276:immunology; D016032:Randomized Controlled Trials as Topic; D012307:Risk Factors; D012462:Saline Solution, Hypertonic / Q000008:administration & dosage* / Q000494:pharmacology; D012771:Shock, Hemorrhagic / Q000276:immunology / Q000401:mortality / Q000628:therapy*; D016019:Survival Analysis; D016896:Treatment Outcome
chemical_list: D012462:Saline Solution, Hypertonic