Efficacy of hypertonic saline dextran fluid resuscitation for patients with hypotension from penetrating trauma

Charles E. Wade, J. J. Grady, George C. Kramer

Research output: Contribution to journalArticle

93 Scopus citations

Abstract

Background: The purpose of this study was to assess whether the administration of hypertonic saline dextran (HSD) was detrimental when administered to patients who were hypotensive because of penetrating injuries to the torso. The administration of HSD causes an immediate and sustained increase in blood pressure that could contribute to an increase in bleeding in the presence of uncontrolled hemorrhage. We prospectively designed a series of questions to be addressed by a meta-analysis of individual patient data using a computerized data file and case report forms from a multicenter study of HSD. Methods: The investigators were "blind" as to the treatment the patient received. Patients (n = 230) with penetrating injuries to the torso were studied as to survival until discharge. The patients were administered 250 mL of HSD or normal saline (standard of care [SOC]) as the initial fluid therapy. Results: Of the 120 patients treated with HSD, 82.5 % survived compared with 75.5% for 110 SOC patients (p = 0.19). Sixty-eight percent (n = 157) of these patients required surgery. HSD treatment (n = 84) in this population improved survival, 84.5% compared with 67.1% with SOC (n = 73) (p = 0.01). HSD resulted in an increase in blood pressure and a reduction in hematocrit, with no differences noted in fluid requirements or indices of clotting. Conclusion: For patients with penetrating injuries to the torso that result in hypotension, initial fluid resuscitation with HSD is beneficial in improving survival, especially if surgery is subsequently required.

Original languageEnglish (US)
Pages (from-to)S144-S148
JournalJournal of Trauma - Injury, Infection and Critical Care
Volume54
Issue number5 SUPPL.
StatePublished - May 1 2003
Externally publishedYes

Keywords

  • Blood pressure
  • Clotting
  • Meta-analysis
  • Resuscitation
  • Uncontrolled bleeding

ASJC Scopus subject areas

  • Surgery
  • Critical Care and Intensive Care Medicine

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