Hypertonic saline in critical illness - A systematic review.

Pfortmüller, Carmen; Schefold, Joerg C. (2017). Hypertonic saline in critical illness - A systematic review. Journal of critical care, 42, pp. 168-177. Elsevier 10.1016/j.jcrc.2017.06.019

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INTRODUCTION The optimal approach to fluid management in critically ill patients is highly debated. Fluid resuscitation using hypertonic saline was used in the past for more than thirty years, but has recently disappeared from clinical practice. Here we provide an overview on the currently available literature on effects of hypertonic saline infusion for fluid resuscitation in the critically ill. METHODS Systematic analysis of reports of clinical trials comparing effects of hypertonic saline as resuscitation fluid to other available crystalloid solutions. A literature search of MEDLINE and the Cochrane Controlled Clinical trials register (CENTRAL) was conducted to identify suitable studies. RESULTS The applied search strategy produced 2284 potential publications. After eliminating doubles, 855 titles and abstracts were screened and 40 references retrieved for full text analysis. At total of 25 scientific studies meet the prespecified inclusion criteria for this study. CONCLUSION Fluid resuscitation using hypertonic saline results in volume expansion and less total infusion volume. This may be of interest in oedematous patients with intravascular volume depletion. When such strategies are employed, renal effects may differ markedly according to prior intravascular volume status. Hypertonic saline induced changes in serum osmolality and electrolytes return to baseline within a limited period in time. Sparse evidence indicates that resuscitation with hypertonic saline results in less perioperative complications, ICU days and mortality in selected patients. In conclusion, the use of hypertonic saline may have beneficial features in selected critically ill patients when carefully chosen. Further clinical studies assessing relevant clinical outcomes are warranted.

Item Type:

Journal Article (Review Article)

Division/Institute:

04 Faculty of Medicine > Department of Intensive Care, Emergency Medicine and Anaesthesiology (DINA) > Clinic of Intensive Care

UniBE Contributor:

Pfortmüller, Carmen and Schefold, Joerg C.

Subjects:

600 Technology > 610 Medicine & health

ISSN:

0883-9441

Publisher:

Elsevier

Language:

English

Submitter:

Mirella Aeberhard

Date Deposited:

30 Oct 2017 15:40

Last Modified:

19 Dec 2017 01:31

Publisher DOI:

10.1016/j.jcrc.2017.06.019

PubMed ID:

28746899

Uncontrolled Keywords:

Critical illness Crystalloid Fluid Resuscitation Saline

BORIS DOI:

10.7892/boris.104862

URI:

https://boris.unibe.ch/id/eprint/104862

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