Hypertonic saline resuscitation in sepsis

The present discussion focuses on the review by Oliveira and coworkers [1] (presented in this issue), and on the use of hypertonic saline resuscitation in sepsis. Early fluid resuscitation of patients with systemic inflammatory response syndrome reduces the incidence of mortality due to septic shock and sepsis [2]. These favorable results have led to consideration of other fluid modalities. In their review, Oliveira and coworkers consider the use of hypertonic saline solutions in the treatment of patients with severe sepsis.Hypertonic saline has been extensively investigated in animal models with regard to its efficacy in treating hemorrhagic hypotension [3]. Numerous clinical studies of patients with traumatic injuries have been initiated with favorable, but not definitive, results [4]. Limited animal studies have been directed at treatment of septic shock using hypertonic solutions, and clinical studies have been exploratory at best. Hannemann and coworkers [5] studied 21 stable patients with septic shock. Patients were administered 2–4 ml/kg hypertonic saline in hydroxyethyl starch. Following administration there was a small effect on oxygenation by increasing cardiac output and oxygen delivery. There was no control group in this study for comparison. An abstract reported by Oliveira an colleagues [6] described a randomized study of 25 stable patients with sepsis.Administration of 250 ml hypertonic saline in dextran significantly improved cardiac index and pulmonary artery occlusion pressure as compared with administration of an equivalent volume of normal saline. Although favorable, those studies of responses to hypertonic saline solutions in stable patients with sepsis are only descriptive. Furthermore, administration of hypertonic saline solutions during the early stages of septic shock when the patient is not yet hyperdynamic has not been investigated.The major benefit of hypertonic solutions is the rapid expansion of blood volume for a small volume administe