Trauma, the leading cause of death in young Americans and the most costly of all health problems in the country, kills most often by either brain injury or hemorrhage. Hemorrhage remains a problems because, in part, it is almost impossible to replenish vascular volume early on, in the field, when the patients are first treated by medical personnel. Adequate volume expansion with conventional intravenous solutions requires large amounts of fluid, and it is impossible to infuse adequate amounts through the small peripheral venous catheters that are mandated by the intensely vasoconstricted veins of the patient in traumatic shock. An intravenous fluid that could achieve resuscitation in small volumes would solve this problem. 7.5% NaCl/6% Dextran 70 may be such a fluid. Hypertonic NaCl/Dextran solutions dramatically resuscitate animals from hemorrhagic shock and, in preliminary clinical studies, work well in patients. The solutions have many attractive features. They are cheap, easy to store, do not freeze at ambient temperatures, and do not support bacterial growth. They are effective no matter how they are administered, whether into a peripheral artery, a peripheral vein, or a large central vein. They work well even when given as a bolus, at least in arrested-hemorrhage animal models. In animal studies they prevent cerebral edema, at least temporarily, and they might be useful in patients with brain injuries. And, the solutions achieve resuscitation with remarkably small volumes. The proposed study will evaluate the use of small volumes (250 ml) of 7.5% NaCl/6% Dextran 70 in the field resuscitation of severely injured patients. The study will be prospective, randomized, and double-blinded and will compare the hypertonic/hyperoncotic solution with a conventionally-used fluid, lactated Ringer's the main hypothesis to be tested is that field administration of small volumes of 7.5% NaCl/6% Dextran 70 can improve blood pressure and survival of these patients during transport to the emergency room and that it can accomplish these ends safely. The study will also evaluate if the solution can decrease the incidence of post-traumatic organ failure and improve overall survival.
| Vassar, M J; Perry, C A; Holcroft, J W (1990) Analysis of potential risks associated with 7.5% sodium chloride resuscitation of traumatic shock. Arch Surg 125:1309-15 |
