Administration of Hypertonic Solutions for Hemorrhagic Shock: A Systematic Review and Meta-Analysis of Clinical Trials
Journal
Anesthesia and Analgesia
Journal Volume
125
Journal Issue
5
Pages
1549-1557
Date Issued
2017
Author(s)
Liao T.-Y.
Lee E.M.
Chen Y.-S.
Hsu W.-T.
Lee M.-T.G.
Tsou P.-Y.
Abstract
BACKGROUND: Several clinical trials on hypertonic fluid administration have been completed, but the results have been inconclusive. The objective of this study is to summarize current evidence for treating hypovolemic patients with hypertonic solutions by performing a systematic review and meta-Analysis. METHODS: Major electronic databases were searched from inception through June 2014. We included only randomized controlled trials involving hemorrhagic shock patients treated with hypertonic solutions. After screening 570 trials, 12 were eligible for the final analysis. Pooled effect estimates were calculated with a random effect model. RESULTS: The 12 studies included 6 trials comparing 7.5% hypertonic saline (HS) with 0.9% saline or Ringer's lactate solution and 11 trials comparing 7.5% hypertonic saline with dextran (HSD) with isotonic saline or Ringer's lactate. Overall, there were no statistically significant survival benefits for patients treated with HS (relative risk [RR], 0.96; 95% confidence interval [CI], 0.82-1.12) or HSD (RR, 0.92; 95% CI, 0.80-1.06). Treatment with hypertonic solutions was also not associated with increased complications (RR, 1.03; 95% CI, 0.78-1.36). Subgroup analysis on trauma patients in the prehospital or emergency department settings did not change these conclusions. There was no evidence of significant publication bias. Meta-regression analysis did not find any significant sources of heterogeneity. CONCLUSIONS: Current evidence does not reveal increased mortality when the administration of isotonic solutions is compared to HS or HSD in trauma patients with hemorrhagic shock. HS or HSD may be a viable alternative resuscitation fluid in the prehospital setting. Further studies are needed to determine the optimum volume and regimen of intravenous fluids for the treatment of trauma patients.
SDGs
Other Subjects
dextran; hypertonic solution; Ringer lactate solution; sodium chloride; dextran; hypertonic saline-dextran solution; isotonic solution; Ringer's lactate; sodium chloride; emergency ward; hemorrhagic shock; hospital infection; human; hypovolemic shock; meta analysis; priority journal; publishing; randomized controlled trial (topic); resuscitation; Review; survival; systematic review; clinical trial (topic); evidence based medicine; fluid therapy; hemodynamics; intravenous drug administration; mortality; odds ratio; pathophysiology; procedures; risk factor; Shock, Hemorrhagic; time factor; treatment outcome; Clinical Trials as Topic; Dextrans; Evidence-Based Medicine; Fluid Therapy; Hemodynamics; Humans; Infusions, Intravenous; Isotonic Solutions; Odds Ratio; Risk Factors; Saline Solution, Hypertonic; Shock, Hemorrhagic; Sodium Chloride; Time Factors; Treatment Outcome
Type
review