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Damage control immunoregulation: is there a role for low-volume hypertonic saline resuscitation in patients managed with damage control surgery?
MedLine Citation:
PMID:  22964205     Owner:  NLM     Status:  In-Data-Review    
Abstract/OtherAbstract:
Hypertonic saline (HTS) is beneficial in the treatment of head-injured patients as a result of its potent cytoprotective effects on various cell lines. We hypothesize that low-volume resuscitation with 3 per cent HTS, when used after damage control surgery (DCS), improves outcomes compared with standard resuscitation with isotonic crystalloid solution (ICS). This is a 4-year retrospective review from two Level I trauma centers. Patients included had 10 units or more of packed red blood cells during initial DCS. On arrival to the trauma intensive care unit (TICU), patients were resuscitated with low-volume 3 per cent HTS or with conventional ICS. A cohort analysis was performed comparing resuscitation strategies. Univariate analysis of continuous data was done with Student t test followed by multivariate analysis. Of 188 patients included, 76 were in the low-volume HTS group and 112 in the ICS group. Demographics were similar between the groups. Over the next 48 hours after DCS in HTS versus ISC groups, intravenous fluids were given: 1920 ± 455 mL versus 8400 ± 1200 mL (P < 0.0001); urine output was 4320 ± 480 mL versus 1940 ± 480 mL(P < 0.0001); mean TICU length of stay was 10 ± 8 versus 16 ± 15 days (P < 0.01); prevalence of acute respiratory distress syndrome was 4.0 versus 13.4 per cent (P = 0.02); sepsis was 6.6 versus 15.2 per cent (P = 0.06); multisystem organ failure was: 2.6 versus 16.1 per cent (P < 0.01); and 30-day mortality was 5.3 versus 15.2 per cent (P = 0.03). There was no difference for prevalence of renal failure at 5.3 versus 3.6 per cent (P = 0.58). Low-volume resuscitation with HTS administered after DCS on arrival to the TICU may have a protective effect on the polytrauma patient. We believe that this study demonstrates a role for low-volume resuscitation with HTS to improve outcomes in patients undergoing DCS.
Authors:
Juan C Duchesne; Eric Simms; Chrissy Guidry; Marquinn Duke; Esther Beeson; Norman E McSwain; Bryan Cotton
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The American surgeon     Volume:  78     ISSN:  1555-9823     ISO Abbreviation:  Am Surg     Publication Date:  2012 Sep 
Date Detail:
Created Date:  2012-09-11     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0370522     Medline TA:  Am Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  962-8     Citation Subset:  IM    
Affiliation:
Trauma/Critical Care, Tulane University School of Medicine, New Orleans, Louisiana, USA.
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