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Clinical Experience Using 5% Hypertonic Saline as a Safe Alternative Fluid for Use in Trauma

DuBose, Joseph J. MD; Kobayashi, Leslie MD; Lozornio, Alfredo MD; Teixeira, Pedro MD; Inaba, Kenji MD; Lam, Lydia MD; Talving, Peep MD, PhD; Branco, Bernardino MD; Demetriades, Demetrios MD, PhD; Rhee, Peter MD, MPH

Journal of Trauma-Injury Infection & Critical Care: May 2010 - Volume 68 - Issue 5 - pp 1172-1177
doi: 10.1097/TA.0b013e3181d76d40
Original Article

Background: Published experience of hypertonic saline (HTS) use in resuscitation has described the use of commercially unavailable 7.5% solutions. The purpose of this study was to compare our experience with the administration of commercially available 5% HTS solution with that of well-matched controls who did not receive HTS.

Methods: Prospective observational study of 51 trauma patients receiving 500 mL of 5% HTS during initial resuscitation. Patients who received HTS were 1:2 matched using age, gender, Injury Severity Score, Coma Score, Head Abbreviated Injury Scale, and injury mechanism to trauma patients who did not receive HTS. The laboratory values and outcomes of the two groups were compared.

Results: Patients receiving HTS demonstrated no difference from the matched cohort in mean pH, international normalized ratio, or p/f ratios at 8 hours or 24 hours. The mean serum sodium of the HTS group was higher than controls at 8 hours (143.1 vs. 150.1 mg/dL, p < 0.001) and remained significantly more increased for 3 days without any adverse sequelae related to hypernatremia. No difference in mortality was noted between the two groups. A trend in decreased mortality was observed in patients with Coma Score ≤8 and Head Abbreviated Injury Scale score ≥3 (25.0% vs. 42.5%). The mean ventilator days were 7.3 for HTS group and 9.2 for the non-HTS group.

Conclusion: Although serum sodium remained increased for several days after HTS administration, no adverse sequelae as a result of hypernatremia resulted. Commercially available 5% HTS solution is safe for use in the resuscitation of trauma patients and may improve outcomes in a selected subset of patients with head injury.

From the Division of Trauma (J.J.D., L.K., A.L., P.T., K.I., L.L., P.T., B.B., D.D.), Los Angeles County, University of Southern California Medical Center, Los Angeles, California; and Department of Surgery (P.R.), University of Arizona, Tucson, Arizona.

Submitted for publication December 19, 2008.

Accepted for publication February 1, 2010.

Presented as a poster at the 67th Annual Meeting of the American Association for the Surgery of Trauma, September 24-27, 2008, Maui, Hawaii.

The authors have no conflict of interest to report and have received no financial or material support related to this article.

Address for reprints: Peter Rhee, MD, MPH, Department of Surgery, 1501 North Campbell Ave., Tucson, AZ 85724; email: prhee@surgery.arizona.edu.

© 2010 Lippincott Williams & Wilkins, Inc.