6 Hypertonic saline resuscitation: a new concept

Early treatment of haemorrhagic shock offers few theoretical, but many practical problems. Ideal or minimum volume replacement, and O₂ carrying capacity, are essential but logistics of pre-hospital management impose severe restrictions on what may, or may not, be done. Scoop-and-run, withheld fluid replacement and small volume resuscitation are alternative strategies under discussion at present. This review covers historical aspects of the introduction of small volume resuscitation, general properties required for its application, toxicological studies, available clinical and experimental data, physical, pharmacological and immune effects, mechanisms of action, prospects for clinical use. The controversial case of its interaction with uncontrolled bleeding is covered. It is concluded that the multiple physical, physiological and immune effects of hypertonic saline resuscitation, many of which require further research suggest potential clinical applications, in the primary treatment of hypovolemic shock, in cardiac surgery with cardiopulmonary bypass and in myocardial infarct. The interaction of hypertonic solutions with pro-inflammatory mediators has barely been scratched, and may induce a critical review of many concepts.