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Role of Hypertonic Solutions in Septic Shock

　　Dr. Vincent[26] then discussed the role of HTS in sepsis. HTS has been shown to increase splanchnic blood flow, improve microcirculation, and reduce bacterial translocation in experimental studies. In an animal model of hemorrhagic shock combined with the administration of lipopolysaccharide (LPS), resuscitation with HTS significantly reduced albumin leak, bronchoalveolar lavage fluid neutrophil counts, and the degree of histopathologic injury compared with resuscitation with Ringer's lactate.[27] Additional beneficial effects of HTS are improved T-cell function and decreased susceptibility to sepsis after hemorrhagic shock. Some of the adverse effects include hypernatremia, hyperchloremic acidosis, hemolysis, and bleeding. There are few human studies evaluating HTS for patients with sepsis. In a small study, HTS was shown to improve parameters of cardiovascular performance in stable septic patients.[28] In that study, 29 patients received either 250 mL of normal saline or HTS (NaCl 7.5%, dextran-70 8%) solutions. The cardiac index and stroke volume index were higher in the HTS group. These differences were apparent 1 hour after the infusion. Sodium levels were higher in the HTS group (less than 150 mEq/L) for 3 hours after the infusion.
　　Finally, Dr. Vincent presented data from his animal laboratory on a sheep model of septic shock treated with HTS. Sheep were made septic by cecal ligation and perforation and were randomized to receive either Ringer's lactate or 6% dextran-70 in 7.5% NaCl. The mean arterial pressure (MAP), cardiac output, and superior mesenteric blood flow were higher in the HTS group. The fluid intake in the HTS group was remarkably less, and the urine output was higher.
Dr. Vincent concluded that although it is too early to consider HTS for septic shock, there are some interesting features, especially in prehospital resuscitation, that make HTS an interesting agent. Future studies are needed.