How do you prefer your resuscitation solution? Do you want a little bit more salt?

In this issue of the Revista Brasileira de Terapia Intensiva, Rios et al.⁽¹⁾ demonstrate the effects of volume replacement with hypertonic saline solution (HSS) on hepatic cytokine production and expression of heat-shock proteins and apoptotic proteins in an animal model of acute pancreatitis. HSS down-regulated liver cytokine production and HSP60 expression in a more robust manner when compared to normal saline solution.

More than 30 years have passed since the first description of HSS as a resuscitation solution in hemorrhagic shock.⁽²⁾ HSS can exert its beneficial effects by mobilizing fluids from intracellular to extracellular compartments and by improving myocardial contractility and microcirculatory flow.⁽³⁾ In addition, it may have immunomodulatory effects.⁽³⁾ Thus, the original rationale based on its osmotic effect that enables small volume resuscitation in hypovolemic shock⁽²⁾ and decreases brain edema after traumatic brain injury⁽⁴⁾ may be too simplistic. The results presented by Rios et al.⁽¹⁾ add to previous demonstrations of benefit from HSS on several different aspects of inflammation and organ function in pre-clinical models of systemic inflammatory response syndrome (SIRS) and sepsis.⁽³⁾ However, human trials have failed to provide convincing evidence of efficacy.⁽⁵⁾ Clearly this potential needs to be examined further, particularly as it is cheap and widely available, but we should wait until more robust clinical data are available.