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Comparison of hypertonic saline versus normal saline on cytokine profile during CABG

DOI: 10.1186/2008-2231-20-49

Keywords: CABG, CPB, Hypertonic saline 5%, Inflammation, IL-6, IL-10

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Abstract:

The present study is a randomized double-blinded clinical trial. 40 patients undergoing CABG were randomized to receive HS 5% or NS before operation. Blood samples were obtained after receiving HS or NS, just before operation, 24 and 48 hours post-operatively. Plasma levels of IL-6 and IL-10 were measured by ELISA.Patients received HS had lower levels of IL-6 and higher level of IL-10 compared with NS group, however these differences were not statistically significant. Results of this study suggest that pre-treatment with small volume hypertonic saline 5% may have beneficial effects on inflammatory response following CABG operation.Infusion of Hypertonic saline (HS) solution increases serum osmolarity and markedly intravascular and interstitial fluid volume expansion, which causes improving hemodynamic status [1]. Fluid resuscitation with various concentrations of HS solutions (1.8% - 7.5%) has been investigated in different types of hypovolemic shock [1]; pre-operative, intra-operative and post-operative fluid therapy [2], burn injury and also septic shock [1]. HS is inexpensive and has no risk of anaphylactoid reactions compared with other artificial plasma volume expanders. There is no risk of transmission of infectious agents compared with human plasma [3]. Rapid correction of intravascular volume is achieved with a small infused volume (4 ml/kg) [1].Recent studies demonstrated immunomodulatory effects of hypertonic saline by blunting neutrophil activation and reducing cytokine production [4,5].Cardiac surgery with cardiopulmonary bypass (CPB) leads to acute changes in the composition and volume of body fluid compartments. CPB dilutes serum proteins, decreases the plasma colloid osmotic pressure and reduces endothelial integrity [6]. This causes fluid shifts from the intravascular to extravascular space and leads to a 33% increase in extravascular fluid space and tissue edema [7]. Complement activation following with systemic inflammatory response syndrome (SIRS

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