Hypertonic resuscitation after severe injury: is it of benefit?

There is a wealth of preclinical data suggesting potential benefit from the administration of hypertonic solutions after severe injury with hypovolemic shock, including improved tissue perfusion, improved flow through the microcirculation, and modulation of the inflammatory response, which may mitigate subsequent organ failure. However, despite these potential advantages, clinical trials of hypertonic resuscitation early after injury have failed to demonstrate significant benefit for resuscitation of hemorrhagic shock, and although there is no difference in overall mortality, there appears to be a trend toward earlier mortality among those receiving hypertonic fluids. Likewise, for TBI there are data suggesting that hypertonic fluids should support cerebral perfusion and mitigate intracranial hypertension, yet the clinical trials of early administration to these patients have also failed to show benefit. Further study is warranted in this patient population, as a longer period of hypertonicity may be required to show a clinical effect. Assessment of long-term neurologic outcome in this patient population remains the gold standard in determining benefit.