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. 2003 Jul;20(4):306–315. doi: 10.1136/emj.20.4.306

Salt of the earth or a drop in the ocean? A pathophysiological approach to fluid resuscitation

P Gosling 1
PMCID: PMC1726159  PMID: 12835337

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Selected References

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  1. Abid O., Sun Q., Sugimoto K., Mercan D., Vincent J. L. Predictive value of microalbuminuria in medical ICU patients: results of a pilot study. Chest. 2001 Dec;120(6):1984–1988. doi: 10.1378/chest.120.6.1984. [DOI] [PubMed] [Google Scholar]
  2. Allison K. P., Gosling P., Jones S., Pallister I., Porter K. M. Randomized trial of hydroxyethyl starch versus gelatine for trauma resuscitation. J Trauma. 1999 Dec;47(6):1114–1121. doi: 10.1097/00005373-199912000-00023. [DOI] [PubMed] [Google Scholar]
  3. Arieff A. I. Fatal postoperative pulmonary edema: pathogenesis and literature review. Chest. 1999 May;115(5):1371–1377. doi: 10.1378/chest.115.5.1371. [DOI] [PubMed] [Google Scholar]
  4. Baldassarre S., Vincent J. L. Coagulopathy induced by hydroxyethyl starch. Anesth Analg. 1997 Feb;84(2):451–453. doi: 10.1097/00000539-199702000-00040. [DOI] [PubMed] [Google Scholar]
  5. Beyer R., Harmening U., Rittmeyer O., Zielmann S., Mielck F., Kazmaier S., Kettler D. Use of modified fluid gelatin and hydroxyethyl starch for colloidal volume replacement in major orthopaedic surgery. Br J Anaesth. 1997 Jan;78(1):44–50. doi: 10.1093/bja/78.1.44. [DOI] [PubMed] [Google Scholar]
  6. Boldt J., Heesen M., Müller M., Pabsdorf M., Hempelmann G. The effects of albumin versus hydroxyethyl starch solution on cardiorespiratory and circulatory variables in critically ill patients. Anesth Analg. 1996 Aug;83(2):254–261. doi: 10.1097/00000539-199608000-00010. [DOI] [PubMed] [Google Scholar]
  7. Boldt J., Heesen M., Padberg W., Martin K., Hempelmann G. The influence of volume therapy and pentoxifylline infusion on circulating adhesion molecules in trauma patients. Anaesthesia. 1996 Jun;51(6):529–535. doi: 10.1111/j.1365-2044.1996.tb12557.x. [DOI] [PubMed] [Google Scholar]
  8. Boldt J., Heesen M., Welters I., Padberg W., Martin K., Hempelmann G. Does the type of volume therapy influence endothelial-related coagulation in the critically ill? Br J Anaesth. 1995 Dec;75(6):740–746. doi: 10.1093/bja/75.6.740. [DOI] [PubMed] [Google Scholar]
  9. Boldt J., Mueller M., Menges T., Papsdorf M., Hempelmann G. Influence of different volume therapy regimens on regulators of the circulation in the critically ill. Br J Anaesth. 1996 Oct;77(4):480–487. doi: 10.1093/bja/77.4.480. [DOI] [PubMed] [Google Scholar]
  10. Brown G. C. Nitric oxide as a competitive inhibitor of oxygen consumption in the mitochondrial respiratory chain. Acta Physiol Scand. 2000 Apr;168(4):667–674. doi: 10.1046/j.1365-201x.2000.00718.x. [DOI] [PubMed] [Google Scholar]
  11. Ciesla D. J., Moore E. E., Zallen G., Biffl W. L., Silliman C. C. Hypertonic saline attenuation of polymorphonuclear neutrophil cytotoxicity: timing is everything. J Trauma. 2000 Mar;48(3):388–395. doi: 10.1097/00005373-200003000-00004. [DOI] [PubMed] [Google Scholar]
  12. Cittanova M. L., Leblanc I., Legendre C., Mouquet C., Riou B., Coriat P. Effect of hydroxyethylstarch in brain-dead kidney donors on renal function in kidney-transplant recipients. Lancet. 1996 Dec 14;348(9042):1620–1622. doi: 10.1016/s0140-6736(96)07588-5. [DOI] [PubMed] [Google Scholar]
  13. Collis R. E., Collins P. W., Gutteridge C. N., Kaul A., Newland A. C., Williams D. M., Webb A. R. The effect of hydroxyethyl starch and other plasma volume substitutes on endothelial cell activation; an in vitro study. Intensive Care Med. 1994;20(1):37–41. doi: 10.1007/BF02425053. [DOI] [PubMed] [Google Scholar]
  14. Corso C. O., Okamoto S., Rüttinger D., Messmer K. Hypertonic saline dextran attenuates leukocyte accumulation in the liver after hemorrhagic shock and resuscitation. J Trauma. 1999 Mar;46(3):417–423. doi: 10.1097/00005373-199903000-00011. [DOI] [PubMed] [Google Scholar]
  15. Cross J. S., Gruber D. P., Burchard K. W., Singh A. K., Moran J. M., Gann D. S. Hypertonic saline fluid therapy following surgery: a prospective study. J Trauma. 1989 Jun;29(6):817–826. doi: 10.1097/00005373-198906000-00020. [DOI] [PubMed] [Google Scholar]
  16. Cunningham J. N., Jr, Shires G. T., Wagner Y. Changes in intracellular sodium and potassium content of red blood cells in trauma and shock. Am J Surg. 1971 Nov;122(5):650–654. doi: 10.1016/0002-9610(71)90293-5. [DOI] [PubMed] [Google Scholar]
  17. Davies M. G., Hagen P. O. Systemic inflammatory response syndrome. Br J Surg. 1997 Jul;84(7):920–935. doi: 10.1002/bjs.1800840707. [DOI] [PubMed] [Google Scholar]
  18. Favre J. B., Ravussin P., Chiolero R., Bissonnette B. Liquides hypertoniques et pression intracrânienne. Schweiz Med Wochenschr. 1996 Sep 28;126(39):1635–1643. [PubMed] [Google Scholar]
  19. Flear C. T., Singh C. M. Hyponatraemia and sick cells. Br J Anaesth. 1973 Sep;45(9):976–994. doi: 10.1093/bja/45.9.976. [DOI] [PubMed] [Google Scholar]
  20. Fleck A., Raines G., Hawker F., Trotter J., Wallace P. I., Ledingham I. M., Calman K. C. Increased vascular permeability: a major cause of hypoalbuminaemia in disease and injury. Lancet. 1985 Apr 6;1(8432):781–784. doi: 10.1016/s0140-6736(85)91447-3. [DOI] [PubMed] [Google Scholar]
  21. Frye R. L. Chronic congestive heart failure. Eight steps in management. Postgrad Med. 1981 Mar;69(3):165–169-74. doi: 10.1080/00325481.1981.11715715. [DOI] [PubMed] [Google Scholar]
  22. Gil M. J., Franch G., Guirao X., Oliva A., Herms R., Salas E., Girvent M., Sitges-Serra A. Response of severely malnourished patients to preoperative parenteral nutrition: a randomized clinical trial of water and sodium restriction. Nutrition. 1997 Jan;13(1):26–31. doi: 10.1016/s0899-9007(97)90875-3. [DOI] [PubMed] [Google Scholar]
  23. Gosling P., Hughes E. A., Reynolds T. M., Fox J. P. Microalbuminuria is an early response following acute myocardial infarction. Eur Heart J. 1991 Apr;12(4):508–513. doi: 10.1093/oxfordjournals.eurheartj.a059931. [DOI] [PubMed] [Google Scholar]
  24. Gosling P., Rittoo D., Manji M., Mahmood A., Vohra R. Hydroxyethylstarch as a risk factor for acute renal failure in severe sepsis. Lancet. 2001 Aug 18;358(9281):581–582. doi: 10.1016/S0140-6736(01)05718-X. [DOI] [PubMed] [Google Scholar]
  25. Gosling Peter, Brudney Scott, McGrath Linda, Riseboro Sophie, Manji Mav. Mortality prediction at admission to intensive care: a comparison of microalbuminuria with acute physiology scores after 24 hours. Crit Care Med. 2003 Jan;31(1):98–103. doi: 10.1097/00003246-200301000-00016. [DOI] [PubMed] [Google Scholar]
  26. Haisch G., Boldt J., Krebs C., Kumle B., Suttner S., Schulz A. The influence of intravascular volume therapy with a new hydroxyethyl starch preparation (6% HES 130/0.4) on coagulation in patients undergoing major abdominal surgery. Anesth Analg. 2001 Mar;92(3):565–571. doi: 10.1097/00000539-200103000-00003. [DOI] [PubMed] [Google Scholar]
  27. Haisch G., Boldt J., Krebs C., Suttner S., Lehmann A., Isgro F. Influence of a new hydroxyethylstarch preparation (HES 130/0.4) on coagulation in cardiac surgical patients. J Cardiothorac Vasc Anesth. 2001 Jun;15(3):316–321. doi: 10.1053/jcan.2001.23276. [DOI] [PubMed] [Google Scholar]
  28. Hannon R. J., Boston V. E. Fluid and ion redistribution in skeletal muscle in an animal sepsis model. J Pediatr Surg. 1990 Jun;25(6):599–603. doi: 10.1016/0022-3468(90)90342-7. [DOI] [PubMed] [Google Scholar]
  29. Hofbauer R., Moser D., Hornykewycz S., Frass M., Kapiotis S. Hydroxyethyl starch reduces the chemotaxis of white cells through endothelial cell monolayers. Transfusion. 1999 Mar;39(3):289–294. doi: 10.1046/j.1537-2995.1999.39399219286.x. [DOI] [PubMed] [Google Scholar]
  30. Junger W. G., Hoyt D. B., Hamreus M., Liu F. C., Herdon-Remelius C., Junger W., Altman A. Hypertonic saline activates protein tyrosine kinases and mitogen-activated protein kinase p38 in T-cells. J Trauma. 1997 Mar;42(3):437–445. doi: 10.1097/00005373-199703000-00011. [DOI] [PubMed] [Google Scholar]
  31. Lobo D. N., Bjarnason K., Field J., Rowlands B. J., Allison S. P. Changes in weight, fluid balance and serum albumin in patients referred for nutritional support. Clin Nutr. 1999 Aug;18(4):197–201. doi: 10.1016/s0261-5614(99)80070-3. [DOI] [PubMed] [Google Scholar]
  32. Lobo D. N., Dube M. G., Neal K. R., Simpson J., Rowlands B. J., Allison S. P. Problems with solutions: drowning in the brine of an inadequate knowledge base. Clin Nutr. 2001 Apr;20(2):125–130. doi: 10.1054/clnu.2000.0154. [DOI] [PubMed] [Google Scholar]
  33. Lobo D. N., Stanga Z., Simpson J. A., Anderson J. A., Rowlands B. J., Allison S. P. Dilution and redistribution effects of rapid 2-litre infusions of 0.9% (w/v) saline and 5% (w/v) dextrose on haematological parameters and serum biochemistry in normal subjects: a double-blind crossover study. Clin Sci (Lond) 2001 Aug;101(2):173–179. [PubMed] [Google Scholar]
  34. Loomis W. H., Namiki S., Hoyt D. B., Junger W. G. Hypertonicity rescues T cells from suppression by trauma-induced anti-inflammatory mediators. Am J Physiol Cell Physiol. 2001 Sep;281(3):C840–C848. doi: 10.1152/ajpcell.2001.281.3.C840. [DOI] [PubMed] [Google Scholar]
  35. MacKinnon K. L., Molnar Z., Lowe D., Watson I. D., Shearer E. Use of microalbuminuria as a predictor of outcome in critically ill patients. Br J Anaesth. 2000 Feb;84(2):239–241. doi: 10.1093/oxfordjournals.bja.a013409. [DOI] [PubMed] [Google Scholar]
  36. Marik P. E., Iglesias J., Maini B. Gastric intramucosal pH changes after volume replacement with hydroxyethyl starch or crystalloid in patients undergoing elective abdominal aortic aneurysm repair. J Crit Care. 1997 Jun;12(2):51–55. doi: 10.1016/s0883-9441(97)90001-0. [DOI] [PubMed] [Google Scholar]
  37. McDonald D. M., Thurston G., Baluk P. Endothelial gaps as sites for plasma leakage in inflammation. Microcirculation. 1999 Mar;6(1):7–22. [PubMed] [Google Scholar]
  38. Murao Y., Hoyt D. B., Loomis W., Namiki S., Patel N., Wolf P., Junger W. G. Does the timing of hypertonic saline resuscitation affect its potential to prevent lung damage? Shock. 2000 Jul;14(1):18–23. doi: 10.1097/00024382-200014010-00004. [DOI] [PubMed] [Google Scholar]
  39. Mythen M. G., Webb A. R. Perioperative plasma volume expansion reduces the incidence of gut mucosal hypoperfusion during cardiac surgery. Arch Surg. 1995 Apr;130(4):423–429. doi: 10.1001/archsurg.1995.01430040085019. [DOI] [PubMed] [Google Scholar]
  40. Oz M. C., FitzPatrick M. F., Zikria B. A., Pinsky D. J., Durán W. N. Attenuation of microvascular permeability dysfunction in postischemic striated muscle by hydroxyethyl starch. Microvasc Res. 1995 Jul;50(1):71–79. doi: 10.1006/mvre.1995.1039. [DOI] [PubMed] [Google Scholar]
  41. Pallister I., Gosling P., Alpar K., Bradley S. Prediction of posttraumatic adult respiratory distress syndrome by albumin excretion rate eight hours after admission. J Trauma. 1997 Jun;42(6):1056–1061. doi: 10.1097/00005373-199706000-00012. [DOI] [PubMed] [Google Scholar]
  42. Partrick D. A., Moore E. E., Offner P. J., Johnson J. L., Tamura D. Y., Silliman C. C. Hypertonic saline activates lipid-primed human neutrophils for enhanced elastase release. J Trauma. 1998 Apr;44(4):592–598. doi: 10.1097/00005373-199804000-00006. [DOI] [PubMed] [Google Scholar]
  43. Peterson B., Khanna S., Fisher B., Marshall L. Prolonged hypernatremia controls elevated intracranial pressure in head-injured pediatric patients. Crit Care Med. 2000 Apr;28(4):1136–1143. doi: 10.1097/00003246-200004000-00037. [DOI] [PubMed] [Google Scholar]
  44. Rittoo D., Gosling P., Bonnici C., Burnley S., Millns P., Simms M. H., Smith S. R. G., Vohra R. K. Splanchnic oxygenation in patients undergoing abdominal aortic aneurysm repair and volume expansion with eloHAES. Cardiovasc Surg. 2002 Apr;10(2):128–133. doi: 10.1016/s0967-2109(01)00132-6. [DOI] [PubMed] [Google Scholar]
  45. Rotstein O. D. Novel strategies for immunomodulation after trauma: revisiting hypertonic saline as a resuscitation strategy for hemorrhagic shock. J Trauma. 2000 Oct;49(4):580–583. doi: 10.1097/00005373-200010000-00002. [DOI] [PubMed] [Google Scholar]
  46. Scalia S. V., Taheri P. A., Force S., Ozmen V., Lui D., Fish J., Hansen D., Chambers R., Flint L., Steinberg S. Mesenteric microcirculatory changes in nonlethal hemorrhagic shock: the role of resuscitation with balanced electrolyte or hypertonic saline/dextran. J Trauma. 1992 Aug;33(2):321–325. [PubMed] [Google Scholar]
  47. Schmand J. F., Ayala A., Morrison M. H., Chaudry I. H. Effects of hydroxyethyl starch after trauma-hemorrhagic shock: restoration of macrophage integrity and prevention of increased circulating interleukin-6 levels. Crit Care Med. 1995 May;23(5):806–814. doi: 10.1097/00003246-199505000-00006. [DOI] [PubMed] [Google Scholar]
  48. Schortgen F., Lacherade J. C., Bruneel F., Cattaneo I., Hemery F., Lemaire F., Brochard L. Effects of hydroxyethylstarch and gelatin on renal function in severe sepsis: a multicentre randomised study. Lancet. 2001 Mar 24;357(9260):911–916. doi: 10.1016/S0140-6736(00)04211-2. [DOI] [PubMed] [Google Scholar]
  49. Shimazaki S., Yukioka T., Matuda H. Fluid distribution and pulmonary dysfunction following burn shock. J Trauma. 1991 May;31(5):623–628. doi: 10.1097/00005373-199105000-00005. [DOI] [PubMed] [Google Scholar]
  50. Simma B., Burger R., Falk M., Sacher P., Fanconi S. A prospective, randomized, and controlled study of fluid management in children with severe head injury: lactated Ringer's solution versus hypertonic saline. Crit Care Med. 1998 Jul;26(7):1265–1270. doi: 10.1097/00003246-199807000-00032. [DOI] [PubMed] [Google Scholar]
  51. Sinclair S., James S., Singer M. Intraoperative intravascular volume optimisation and length of hospital stay after repair of proximal femoral fracture: randomised controlled trial. BMJ. 1997 Oct 11;315(7113):909–912. doi: 10.1136/bmj.315.7113.909. [DOI] [PMC free article] [PubMed] [Google Scholar]
  52. Smith F. C., Gosling P., Sanghera K., Green M. A., Paterson I. S., Shearman C. P. Microproteinuria predicts the severity of systemic effects of reperfusion injury following infrarenal aortic aneurysm surgery. Ann Vasc Surg. 1994 Jan;8(1):1–5. doi: 10.1007/BF02133398. [DOI] [PubMed] [Google Scholar]
  53. Starker P. M., Lasala P. A., Askanazi J., Gump F. E., Forse R. A., Kinney J. M. The response to TPN. A form of nutritional assessment. Ann Surg. 1983 Dec;198(6):720–724. doi: 10.1097/00000658-198312000-00010. [DOI] [PMC free article] [PubMed] [Google Scholar]
  54. Stone H. H., Fulenwider J. T. Renal decapsulation in the prevention of post-ischemic oliguria. Ann Surg. 1977 Sep;186(3):343–355. doi: 10.1097/00000658-197709000-00012. [DOI] [PMC free article] [PubMed] [Google Scholar]
  55. Stoneham M. D., Hill E. L. Variability in post-operative fluid and electrolyte prescription. Br J Clin Pract. 1997 Mar;51(2):82–84. [PubMed] [Google Scholar]
  56. Thompson W. L. Rational use of albumin and plasma substitutes. Johns Hopkins Med J. 1975 May;136(5):220–225. [PubMed] [Google Scholar]
  57. Vassar M. J., Fischer R. P., O'Brien P. E., Bachulis B. L., Chambers J. A., Hoyt D. B., Holcroft J. W. A multicenter trial for resuscitation of injured patients with 7.5% sodium chloride. The effect of added dextran 70. The Multicenter Group for the Study of Hypertonic Saline in Trauma Patients. Arch Surg. 1993 Sep;128(9):1003–1013. doi: 10.1001/archsurg.1993.01420210067009. [DOI] [PubMed] [Google Scholar]
  58. Wade C. E., Grady J. J., Kramer G. C., Younes R. N., Gehlsen K., Holcroft J. W. Individual patient cohort analysis of the efficacy of hypertonic saline/dextran in patients with traumatic brain injury and hypotension. J Trauma. 1997 May;42(5 Suppl):S61–S65. doi: 10.1097/00005373-199705001-00011. [DOI] [PubMed] [Google Scholar]
  59. Waters J. H., Bernstein C. A. Dilutional acidosis following hetastarch or albumin in healthy volunteers. Anesthesiology. 2000 Nov;93(5):1184–1187. doi: 10.1097/00000542-200011000-00008. [DOI] [PubMed] [Google Scholar]
  60. Wilcox C. S. Regulation of renal blood flow by plasma chloride. J Clin Invest. 1983 Mar;71(3):726–735. doi: 10.1172/JCI110820. [DOI] [PMC free article] [PubMed] [Google Scholar]
  61. Williams E. L., Hildebrand K. L., McCormick S. A., Bedel M. J. The effect of intravenous lactated Ringer's solution versus 0.9% sodium chloride solution on serum osmolality in human volunteers. Anesth Analg. 1999 May;88(5):999–1003. doi: 10.1097/00000539-199905000-00006. [DOI] [PubMed] [Google Scholar]
  62. Younes R. N., Yin K. C., Amino C. J., Itinoshe M., Rocha e Silva M., Birolini D. Use of pentastarch solution in the treatment of patients with hemorrhagic hypovolemia: randomized phase II study in the emergency room. World J Surg. 1998 Jan;22(1):2–5. doi: 10.1007/s002689900340. [DOI] [PubMed] [Google Scholar]
  63. Yu A. S., Hu K. Q. Management of ascites. Clin Liver Dis. 2001 May;5(2):541-68, viii. doi: 10.1016/s1089-3261(05)70177-x. [DOI] [PubMed] [Google Scholar]

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