Hypertonic saline for peri-operative fluid management

McAlister V, Burns KEA, Znajda T, Church B

Published Online:

January 20, 2010

Patients usually require intravenous fluids during surgery. Sometimes large volumes of fluid are given during operations in order to maintain adequate blood pressure, but these volumes may leave patients with an excessive fluid load in the post-operative period. Hypertonic saline has a higher sodium concentration than isotonic solutions which have concentrations similar to the blood stream. Hypertonic saline might benefit patients undergoing surgery by reducing the total volume of fluid required. This review includes 15 trials comparing hypertonic saline to isotonic saline in patients undergoing surgery. These trials suggests that less fluid is required for maintenance of arterial blood pressure and blood volume in these patients during surgery if hypertonic saline is given. Kidney function was good in both groups but the serum sodium was higher in patients given hypertonic saline. The trials were too small to see important differences in patient survival or organ failure.

Abstract (click to read)

Background:

Fluid excess may place patients undergoing surgery at risk for various complications. Hypertonic saline (HS) maintains intravascular volume with less intravenous fluid than isotonic salt (IS) solutions, but may increase serum sodium.

Objectives:

To determine the benefits and harms of HS versus IS solutions administered to patients undergoing surgery.

Search strategy:

We searched the Cochrane Central Register of Controlled Trials (CENTRAL), (The Cochrane Library) Issue 1, 2009; MEDLINE (1966 to 2009); EMBASE (1980 to 2009); LILACS (to August 2009) and CINAHL (1982 to 2009) without language restrictions.

Selection criteria:

We included randomized clinical trials where HS was compared to IS in patients undergoing surgery, irrespective of blinding, language, and publication status.

Data collection and analysis:

We assessed the impact of HS administration on mortality, organ failure, fluid balance, serum sodium, serum osmolarity, diuresis and physiologic measures of cardiovascular function. We pooled data using odds ratio or mean difference (MD) for binary and continuous outcomes, respectively, using random-effects models.

Main results:

We included 15 studies with 614 participants. One death in each group and no other serious adverse events were reported. While all patients were in a positive fluid balance postoperatively, the excess was significantly less in HS patients (standardized mean difference (SMD) -1.43L, 95% confidence interval (CI) 0.8 to 2.1 L less; P < 0.00001). Patients treated with HS received significantly less fluid than IS-treated patients (MD -2.4L 95% (CI) 1.5 to 3.2 L less; P < 0.00001) without differences in diuresis between the groups. Maximum intraoperative cardiac index was significantly increased with HS (SMD 0.6 L/min/M2 higher, 95% CI 0.1 to 1.0, P = 0.02) but Intraoperative pulmonary artery wedge pressure remained unchanged. While the maximum serum sodium and the serum sodium at the end of the study were significantly higher in HS patients, the level remained within normal limits (136 to 146 meq/L).

Authors' conclusions:

HS reduces the volume of intravenous fluid required to maintain patients undergoing surgery but transiently increases serum sodium. It is not known if HS effects patient survival and morbidity but it should be tested in randomized clinical trials that are designed and powered to test these outcomes.

This record should be cited as:

McAlister V, Burns KEA, Znajda T, Church B. Hypertonic saline for peri-operative fluid management. Cochrane Database of Systematic Reviews 2010, Issue 1. Art. No.: CD005576. DOI: 10.1002/14651858.CD005576.pub2

Assessed as up to date:

August 1, 2009

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Primary Review Group:

Anaesthesia Group

Health topics:

Anaesthesia & pain control > Peri-anaesthetic/peri-operative care > Fluid management

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Hypertonic saline for peri-operative fluid management

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