The primary factor rendering patients at risk of developing multiple system organ failure after
shock and
trauma is the persistence of impaired microcirculation along with its sequelae for cellular and organ function. Bolus infusion (2-5 min) of 4 ml/kg hypertonic/hyperoncotic
saline solution through a peripheral vein is a new concept for primary
resuscitation from severe
hypovolemia associated with
trauma and
hemorrhage and is termed "small-volume
resuscitation". The experimental data obtained by various research groups have demonstrated the efficacy of 7.2%-7.5%
saline solution in restoring central hemodynamics and organ blood flow. The simultaneous application of a hyperoncotic
colloid (6%-10%
dextran 60/70; 6%-10% hydroxyethylstarch 200,000) aims at prolonging the circulatory effect of saline. Of particular importance are the data obtained in experiments on traumatic-hemorrhagic
hypovolemia in beagles, which proved that the infusion of 10%
dextran 60 in 7.2% saline (hypertonic-hyperoncotic
solution) restores nutritional blood flow within less than 5 min, thereby enhancing the circulatory effect of hypertonic saline alone. In the pre-clinical setting, small-volume
resuscitation by means of
hypertonic saline/dextran solution is aimed at the rapid normalization of the compromised microcirculation and, thus, at the prevention of late complications such as
sepsis and multiple system organ failure. The novelty of hypertonic saline/
dextran resuscitation lies in its operational mechanism at the microcirculatory level, which also renders this concept attractive for volume support in
endotoxemia and
septic shock.(ABSTRACT TRUNCATED AT 250 WORDS)