Cerebral effects of resuscitation with hypertonic saline and a new low- sodium hypertonic fluid in hemorrhagic shock and head injury

Azad A. Sheikh, Tetsuya Matsuoka, David H Wisner

Research output: Contribution to journalArticle

26 Citations (Scopus)

Abstract

Objectives: A 2400-mOsm/L hypertonic solution (Isosal) with a lower sodium content, compared with conventional 7.5% hypertonic saline, was formulated using a mixture of sodium chloride, glucose, and mixed amino acids. This solution was developed to minimize hypernatremia during resuscitation. We assessed the effects of isosal on hemodynamics, brain edema, and plasma sodium concentration after head injury associated with hemorrhagic shock. Design: Prospective, randomized laboratory study. Setting: University research laboratory. Subjects: Twenty-one adult female Suffolk sheep, weighing 39 to 49 kg. Interventions: Animals were subjected to a 2-hr period of hemorrhagic shock to a mean arterial pressure (MAP) of 40 to 45 mm Hg in the presence of a freeze injury to the cerebral cortex. The hemorrhagic shock/head injury phase was followed by 2 hrs of resuscitation with isosal, a new 2400-mosm/L low-sodium hypertonic fluid, 2400 mosm/L of 7.5% hypertonic saline, or lactated Ringer's solution. Initial resuscitation was with a bolus injection of 8 mL/kg of the study solution; subsequent resuscitation in all three groups was with lactated Ringer's solution as needed to maintain baseline cardiac output. Measurements and Main Results: Serial hemodynamics, intracranial pressure, electrolytes, and osmolarity were measured. At the end of resuscitation, the animals were killed and brain water content (mL H2O/g dry weight) of the injured and uninjured areas was determined. Resuscitation volumes were significantly lower in the isosal (19 ± 5 mL/kg) and 7.5% hypertonic saline (14 ± 2 mL/kg) groups compared with the lactated Ringer's solution (35 ± 5 mL/kg) group. Intracranial pressure after 2 hrs of resuscitation was significantly lower in the isosal (7 ± 1 mm Hg) and hypertonic saline groups (4 ± 1 mm Hg), compared with the lactated Ringer's solution group (11 ± 2 mm Hg). Water content in all areas of the brain was significantly lower in the hypertonic saline group compared with the lactated Ringer's solution group. Brain water content in the isosal group was lower than in the lactated Ringer's solution group only in the cerebellum. Plasma sodium content was lower in the isosal group than in the hypertonic saline group. Conclusions: After combined head injury and shock, isosal and 7.5% hypertonic saline have similar effects on hemodynamics and intracranial pressure. Hypertonic saline induces a greater degree of brain dehydration; isosal resuscitation results in smaller increases in plasma sodium.

Original languageEnglish (US)
Pages (from-to)1226-1232
Number of pages7
JournalCritical Care Medicine
Volume24
Issue number7
DOIs
StatePublished - Jul 1996

Fingerprint

Hemorrhagic Shock
Craniocerebral Trauma
Resuscitation
Sodium
Intracranial Pressure
Hemodynamics
Brain
Water
Hypernatremia
Hypertonic Solutions
isosal
Brain Edema
Dehydration
Sodium Chloride
Cardiac Output
Cerebral Cortex
Osmolar Concentration
Cerebellum
Electrolytes
Ringer's solution

Keywords

  • amino acids
  • brain
  • critical illness
  • glucose
  • head injury
  • hemorrhagic shock
  • hypernatremia
  • hypertonic saline
  • neurologic emergencies
  • sodium
  • trauma

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

Cite this

Cerebral effects of resuscitation with hypertonic saline and a new low- sodium hypertonic fluid in hemorrhagic shock and head injury. / Sheikh, Azad A.; Matsuoka, Tetsuya; Wisner, David H.

In: Critical Care Medicine, Vol. 24, No. 7, 07.1996, p. 1226-1232.

Research output: Contribution to journalArticle

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abstract = "Objectives: A 2400-mOsm/L hypertonic solution (Isosal) with a lower sodium content, compared with conventional 7.5{\%} hypertonic saline, was formulated using a mixture of sodium chloride, glucose, and mixed amino acids. This solution was developed to minimize hypernatremia during resuscitation. We assessed the effects of isosal on hemodynamics, brain edema, and plasma sodium concentration after head injury associated with hemorrhagic shock. Design: Prospective, randomized laboratory study. Setting: University research laboratory. Subjects: Twenty-one adult female Suffolk sheep, weighing 39 to 49 kg. Interventions: Animals were subjected to a 2-hr period of hemorrhagic shock to a mean arterial pressure (MAP) of 40 to 45 mm Hg in the presence of a freeze injury to the cerebral cortex. The hemorrhagic shock/head injury phase was followed by 2 hrs of resuscitation with isosal, a new 2400-mosm/L low-sodium hypertonic fluid, 2400 mosm/L of 7.5{\%} hypertonic saline, or lactated Ringer's solution. Initial resuscitation was with a bolus injection of 8 mL/kg of the study solution; subsequent resuscitation in all three groups was with lactated Ringer's solution as needed to maintain baseline cardiac output. Measurements and Main Results: Serial hemodynamics, intracranial pressure, electrolytes, and osmolarity were measured. At the end of resuscitation, the animals were killed and brain water content (mL H2O/g dry weight) of the injured and uninjured areas was determined. Resuscitation volumes were significantly lower in the isosal (19 ± 5 mL/kg) and 7.5{\%} hypertonic saline (14 ± 2 mL/kg) groups compared with the lactated Ringer's solution (35 ± 5 mL/kg) group. Intracranial pressure after 2 hrs of resuscitation was significantly lower in the isosal (7 ± 1 mm Hg) and hypertonic saline groups (4 ± 1 mm Hg), compared with the lactated Ringer's solution group (11 ± 2 mm Hg). Water content in all areas of the brain was significantly lower in the hypertonic saline group compared with the lactated Ringer's solution group. Brain water content in the isosal group was lower than in the lactated Ringer's solution group only in the cerebellum. Plasma sodium content was lower in the isosal group than in the hypertonic saline group. Conclusions: After combined head injury and shock, isosal and 7.5{\%} hypertonic saline have similar effects on hemodynamics and intracranial pressure. Hypertonic saline induces a greater degree of brain dehydration; isosal resuscitation results in smaller increases in plasma sodium.",
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AU - Matsuoka, Tetsuya

AU - Wisner, David H

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N2 - Objectives: A 2400-mOsm/L hypertonic solution (Isosal) with a lower sodium content, compared with conventional 7.5% hypertonic saline, was formulated using a mixture of sodium chloride, glucose, and mixed amino acids. This solution was developed to minimize hypernatremia during resuscitation. We assessed the effects of isosal on hemodynamics, brain edema, and plasma sodium concentration after head injury associated with hemorrhagic shock. Design: Prospective, randomized laboratory study. Setting: University research laboratory. Subjects: Twenty-one adult female Suffolk sheep, weighing 39 to 49 kg. Interventions: Animals were subjected to a 2-hr period of hemorrhagic shock to a mean arterial pressure (MAP) of 40 to 45 mm Hg in the presence of a freeze injury to the cerebral cortex. The hemorrhagic shock/head injury phase was followed by 2 hrs of resuscitation with isosal, a new 2400-mosm/L low-sodium hypertonic fluid, 2400 mosm/L of 7.5% hypertonic saline, or lactated Ringer's solution. Initial resuscitation was with a bolus injection of 8 mL/kg of the study solution; subsequent resuscitation in all three groups was with lactated Ringer's solution as needed to maintain baseline cardiac output. Measurements and Main Results: Serial hemodynamics, intracranial pressure, electrolytes, and osmolarity were measured. At the end of resuscitation, the animals were killed and brain water content (mL H2O/g dry weight) of the injured and uninjured areas was determined. Resuscitation volumes were significantly lower in the isosal (19 ± 5 mL/kg) and 7.5% hypertonic saline (14 ± 2 mL/kg) groups compared with the lactated Ringer's solution (35 ± 5 mL/kg) group. Intracranial pressure after 2 hrs of resuscitation was significantly lower in the isosal (7 ± 1 mm Hg) and hypertonic saline groups (4 ± 1 mm Hg), compared with the lactated Ringer's solution group (11 ± 2 mm Hg). Water content in all areas of the brain was significantly lower in the hypertonic saline group compared with the lactated Ringer's solution group. Brain water content in the isosal group was lower than in the lactated Ringer's solution group only in the cerebellum. Plasma sodium content was lower in the isosal group than in the hypertonic saline group. Conclusions: After combined head injury and shock, isosal and 7.5% hypertonic saline have similar effects on hemodynamics and intracranial pressure. Hypertonic saline induces a greater degree of brain dehydration; isosal resuscitation results in smaller increases in plasma sodium.

AB - Objectives: A 2400-mOsm/L hypertonic solution (Isosal) with a lower sodium content, compared with conventional 7.5% hypertonic saline, was formulated using a mixture of sodium chloride, glucose, and mixed amino acids. This solution was developed to minimize hypernatremia during resuscitation. We assessed the effects of isosal on hemodynamics, brain edema, and plasma sodium concentration after head injury associated with hemorrhagic shock. Design: Prospective, randomized laboratory study. Setting: University research laboratory. Subjects: Twenty-one adult female Suffolk sheep, weighing 39 to 49 kg. Interventions: Animals were subjected to a 2-hr period of hemorrhagic shock to a mean arterial pressure (MAP) of 40 to 45 mm Hg in the presence of a freeze injury to the cerebral cortex. The hemorrhagic shock/head injury phase was followed by 2 hrs of resuscitation with isosal, a new 2400-mosm/L low-sodium hypertonic fluid, 2400 mosm/L of 7.5% hypertonic saline, or lactated Ringer's solution. Initial resuscitation was with a bolus injection of 8 mL/kg of the study solution; subsequent resuscitation in all three groups was with lactated Ringer's solution as needed to maintain baseline cardiac output. Measurements and Main Results: Serial hemodynamics, intracranial pressure, electrolytes, and osmolarity were measured. At the end of resuscitation, the animals were killed and brain water content (mL H2O/g dry weight) of the injured and uninjured areas was determined. Resuscitation volumes were significantly lower in the isosal (19 ± 5 mL/kg) and 7.5% hypertonic saline (14 ± 2 mL/kg) groups compared with the lactated Ringer's solution (35 ± 5 mL/kg) group. Intracranial pressure after 2 hrs of resuscitation was significantly lower in the isosal (7 ± 1 mm Hg) and hypertonic saline groups (4 ± 1 mm Hg), compared with the lactated Ringer's solution group (11 ± 2 mm Hg). Water content in all areas of the brain was significantly lower in the hypertonic saline group compared with the lactated Ringer's solution group. Brain water content in the isosal group was lower than in the lactated Ringer's solution group only in the cerebellum. Plasma sodium content was lower in the isosal group than in the hypertonic saline group. Conclusions: After combined head injury and shock, isosal and 7.5% hypertonic saline have similar effects on hemodynamics and intracranial pressure. Hypertonic saline induces a greater degree of brain dehydration; isosal resuscitation results in smaller increases in plasma sodium.

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KW - critical illness

KW - glucose

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KW - hemorrhagic shock

KW - hypernatremia

KW - hypertonic saline

KW - neurologic emergencies

KW - sodium

KW - trauma

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