Effects of hypertonic saline versus lactated Ringer's solution on cerebral oxygen transport during resuscitation from hemorrhagic shock

Donald S. ProughDepartments of Anesthesia (Section on Critical Care), Neurology, and Surgery, Wake Forest University Medical Center, Bowman Gray School of Medicine, Winston-Salem, North Carolina

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J. Carson JohnsonDepartments of Anesthesia (Section on Critical Care), Neurology, and Surgery, Wake Forest University Medical Center, Bowman Gray School of Medicine, Winston-Salem, North Carolina

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David A. StumpDepartments of Anesthesia (Section on Critical Care), Neurology, and Surgery, Wake Forest University Medical Center, Bowman Gray School of Medicine, Winston-Salem, North Carolina

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Edward H. StullkenDepartments of Anesthesia (Section on Critical Care), Neurology, and Surgery, Wake Forest University Medical Center, Bowman Gray School of Medicine, Winston-Salem, North Carolina

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Galen V. Poole Jr.Departments of Anesthesia (Section on Critical Care), Neurology, and Surgery, Wake Forest University Medical Center, Bowman Gray School of Medicine, Winston-Salem, North Carolina

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George HowardDepartments of Anesthesia (Section on Critical Care), Neurology, and Surgery, Wake Forest University Medical Center, Bowman Gray School of Medicine, Winston-Salem, North Carolina

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✓ Hypertonic saline successfully restores systemic hemodynamics in dogs and humans with severe hemorrhagic shock and, in contrast to lactated Ringer's solution, does not increase intracranial pressure (ICP). This study compares cerebral oxygen delivery in 12 dogs subjected to hemorrhagic shock by the rapid removal of blood (mean arterial pressure of 40 mm Hg maintained for 30 minutes), and then resuscitated with lactated Ringer's solution (six dogs) or 7.5% saline solution (six dogs) to restore systolic arterial pressure. Both solutions effectively restored systemic hemodynamic stability, increasing cardiac output and systolic blood pressure while decreasing mean and diastolic arterial pressure and systemic vascular resistance. The ICP was significantly lower after resuscitation in the hypertonic saline group (p < 0.05), but cerebral blood flow, which had decreased during shock, was not restored by either fluid, and cerebral oxygen transport fell further secondary to a hemodilutional reduction of hemoglobin. Although hypertonic saline may improve systemic hemodynamics and maintain a low ICP during resuscitation, it fails, as does Ringer's solution, to restore cerebral oxygen transport to prehemorrhagic shock levels.

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