Comparison of normal saline, hypertonic saline and hypertonic saline colloid resuscitation fluids in an infant animal model of hypovolemic shock.

PURPOSE: Incorrect resuscitation after hypovolemic shock is a major contributor to preventable pediatric death. Several studies have demonstrated that small volumes of hypertonic or hypertonic-hyperoncotic saline can be an effective initial resuscitation solution. However, there are no pediatric studies to recommend their use. The aim of this study is to determine if in an infant animal model of hemorrhagic shock, the use of hypertonic fluids, as opposed to isotonic crystalloids, would improve global hemodynamic and perfusion parameters.

METHODS: Experimental, randomized animal study including thirty-four 2-to-3-month-old piglets. 30 min after controlled 30 mL kg(-1) bleed, pigs were randomized to receive either normal saline (NS) 30 mL kg(-1) (n=11), 3% hypertonic saline (HS) 15 mL kg(-1) (n=12), or 5% albumin plus 3% hypertonic saline (AHS) 15 mL kg(-1) (n=11).

RESULTS: High baseline heart rate (HR) and low mean arterial pressure (MAP), cardiac index (CI), brain tissue oxygenation index (bTOI), and lactate were recorded 30 min after volume withdrawal, with no significant differences between groups. Thirty minutes after volume replacement there were no significant differences between groups for HR (NS, 188±14; HS, 184±14; AHS, 151±14 bpm); MAP (NS, 80±7; HS, 86±7; AHS, 87±7 mmHg); CI (NS, 4.1±0.4; HS, 3.9±0.4; AHS, 5.1±0.4 mL min(-1)m(-2)); lactate (NS, 2.8±0.7; HS, 2.3±0.6; AHS, 2.4±0.6 mmol L(-1)); bTOI (NS, 43.9±2.2; HS, 40.1±2.5; AHS, 46.1±2.3%).

CONCLUSIONS: In this model of hypovolemic shock, hypertonic fluids achieved similar end-points as twice the volume of NS. Animals treated with albumin plus hypertonic saline presented prolonged increase in blood volume parameters and recovery of the oxygen debt.