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Administration of Hypertonic Solutions for Hemorrhagic Shock: A Systematic Review and Meta-analysis of Clinical Trials

Wu, Meng-Che MD*†‡; Liao, Tin-Yun MD§; Lee, Erica M. BSPS; Chen, Yueh-Sheng MD; Hsu, Wan-Ting MS‡#; Lee, Meng-tse Gabriel PhD*‡; Tsou, Po-Yang MD, MPH**; Chen, Shyr-Chyr MD, MBA*†; Lee, Chien-Chang MD, ScD*‡

doi: 10.1213/ANE.0000000000002451
Trauma: Meta-Analysis

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.

From the *Department of Emergency Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan; Department of Surgery and Department of Emergency Medicine, Health Economics and Outcome Research Group, National Taiwan University Hospital, Taipei, Taiwan; §Department of Physical Medicine and Rehabilitation, Veterans General Hospital, Kaohsiung, Taiwan; Bill Gatton College of Pharmacy, East Tennessee State University, Johnson City, Tennessee; Department of Radiology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan; and #Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; **Bloomberg School of Public Health, John Hopkins University, Baltimore, Maryland.

Accepted for publication July 27, 2017.

Funding: This study is supported by the Taiwan Ministry of Science and Technology Grant MOST104-2314-B-002-039-MY3; MOST 105-2811-B-002-031 and National Taiwan University Hospital Yunlin Branch Research Grant NTUH106-P04 and 105FTN14. No funding bodies had any role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript.

The authors declare no conflicts of interest.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website.

The authors M.-C. Wu and T.-Y. Liao contributed equally to this study.

Reprints will not be available from the authors.

Address correspondence to Chien-Chang Lee, MD, ScD, Health Economics and Outcome Research Group, National Taiwan University Hospital, Department of Emergency Medicine, National Taiwan University Hospital, No. 7, Chung Shan S. Rd, Zhongzheng Dist., Taipei City 100, Taiwan. Address e-mail to cclee100@gmail.com.

© 2017 International Anesthesia Research Society
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