Joseph Bellal, Aziz Hassan, Snell Margeaux, Pandit Viraj, Hays Daniel, Kulvatunyou Narong, Tang Andrew, O'Keeffe Terence, Wynne Julie, Friese Randall S, Rhee Peter
Section of Trauma, Emergency Surgery, Critical Care, and Burns, Department of Surgery, College of Medicine, University of Arizona College of Medicine, 1501 North Campbell Avenue, PO Box 245063, Tucson, AZ 85724-5063, USA.
Section of Trauma, Emergency Surgery, Critical Care, and Burns, Department of Surgery, College of Medicine, University of Arizona College of Medicine, 1501 North Campbell Avenue, PO Box 245063, Tucson, AZ 85724-5063, USA.
Am J Surg. 2014 Nov;208(5):697-702. doi: 10.1016/j.amjsurg.2014.01.009. Epub 2014 Apr 5.
Use of 5% normal saline (NS) is gaining renewed interest. The primary aim of our study was to compare the physiological effects after the administration of different concentrations of hypertonic saline (3% vs 5%NS) in the initial resuscitation of trauma.
We performed a retrospective analysis of a prospectively collected database of all trauma patients who received hypertonic saline during initial resuscitation. Medical records were reviewed for serum electrolytes and serum osmolarity, coagulation parameters, complications, and mortality.
A total of 212 patients were included in the study, of which 170 patients received 5%NS and 42 patients received 3%NS. Both groups were similar in age (41.16 ± 19 vs 44.17 + 23.6; P = .45) and ISS score (26 [17 to 29] vs 25 [16 to 27]; P = .6). Mean serum osmolarity (316 ± 20.3 vs 294 ± 22.5; P = .02) and serum sodium levels (143 ± 8.6 vs 137 ± 10.9; P < .001) remained higher in the 5%NS group within 72 hours of admission. The pH was lower in the 5%NS group compared with the 3%NS group at 24 hours (7.29 ± .12 vs 7.33 ± .12; P = .01); however, at 48 and 72 hours (7.40 ± .07 vs 7.41 ± .07; P = .7), no difference was found. There was no difference in blood products requirement (1,734 vs 2,253 mL; P = .11) between the 2 groups.
The 5%NS has sustained higher serum osmolarity and serum sodium concentration within the first 72 hours without any increase in adverse effects in comparison with 3%NS.
