USE OF HYPERTONIC SALINE SOLUTIONS IN THE INTENSIVE-CARE UNIT

The use of small volumes of hypertonic saline (HTS) 7.2 - 7.5 % (small volume resuscitation) in combination with colloidal solutions has bee n proved to be of value in stabilizing oxygen transport in hemorrhagic shock. The specific effects of HTS lead to an improvement in tissue o xygenation by increasing the cardiac preload, decreasing the afterload and endothelial and interstitial edema within the microcirculation. T his study investigates wheter the use of HTS combined with hydroxyethy lstarch (HAES) leads to a significant increase in the O2 delivery (DO2 ) and O2 consumption (VO2) in hyperdynamic critically ill patients. A total of 41 patients, 20 septic patients and 21 patients without sepsi s were investigated. When a hyperdynamic circulation (DO2 > 700 ml/min /m2) was attained, 2 - 4 ml/kg 7.5 % HTS in 6 % HAES were infused over 15 minutes. In the septic patients this leads to a significant increa se in the DO2 of 14 % (p < 0.001). The VO2 (calculated from the cardio vascular Fick) increased by 7 % (p < 0.05). The VO2 calculated from th e respiratory gases increased by 4 % (n. s.). This < 10 % increase in VO2 does not seem to be due to a relevant tissue oxygen debt. This is supported by the fact that in the non septic group the DO2 and VO2 inc reased by the same extent, there was no significant difference between the two groups. Further there was an equal increase in the O2 extract ion ratio of 10 % (septic patients) and 9.5 % (non septic patients). I n both groups the mean plasma lactate levels before and 90 min after t he HTS/HAES infusion were within normal range so that a wash-out pheno menon was not discernible. However, disturbance of regional tissue oxy genation cannot be excluded. With its specific effects HTS seems usefu l in the initial phase of hypovolemic septic shock.