HYPERTONIC SALINE RESUSCITATION

摘要: Treatment of severe hemorrhage offers few theoretical problems, but in practice, blood loss usually occurs out hospital, often more or less inaccessible scenarios. Controversy rages over ideal fluid, volume, and minimum O2 carrying capacity, all agree that pre-hospital, isotonic resuscitation is unfeasible. The effects highly hypertonic 7.5% NaCl (HS) was first described 1980, when we showed it induced immediate long lasting hemodynamic restoration. addition 6% dextran-70 to (HSD) significantly enhances the duration intensity volume expansion, with no effects. HS/HSD restores cardiac output, arterial pressure, base excess oxygen availability, induce pre-capillary vasodialtion, moderate hyperosmolarity hypernatremia, reversal high glucose lactate. It interferes endocrine secretions administered animals hemorrhagic hypotension. HS acts through transient plasma positive inotropic effect on contractility, precapillary vasodilation a direct action vascular smooth muscle. Expansion circulating part mechanism, extra coming from intracellular compartment especially endothelial red cells, which facilitate microcirculatory flow. new field interactions hypertonicity immune mechanisms may provide insight into solutions. Randomized double blind prospective studies HS, HSD, used as treatment shock show both are safe free collateral, toxic These an early significant rise pressure non-significant trend towards higher levels survival. HSD administration patients about undergo cardiopulmonary bypass for surgery results output before, immediately following bypass, well zero fluid balance.