Hypertonic Saline Resuscitation Restores Inflammatory Cytokine Balance in Post-Traumatic Hemorrhagic Shock Patients


  1. Rhind, S.G.
  2. Rizoli, S.B.
  3. Shek, P.N.
  4. Inaba, K.
  5. Filips, D.
  6. Tien, H.
  7. Brenneman, F.
  8. Rotstein, O.D.
Corporate Authors
Defence R&D Canada - Toronto, Toronto ONT (CAN)
Fluid resuscitation can often exacerbate injury sustained during hemorrhagic shock and is associated with altered immuno-inflammatory events. Early monocyte dysregulation and excessive proinflammatory cytokine production are thought to play a key role in the development of post-traumatic multiorgan dysfunction in resuscitated trauma patients. Compared with standard isotonic crystalloid resuscitation using 0.9% normal saline (NS), 7.5% hypertonic saline with 6% dextran-70 (HSD) has been shown in experimental studies to reduce shock/resuscitation-induced inflammatory reactions and lessen organ dysfunction. However, the immunomodulatory capacity of HSD, has not been evaluated in clinical human trials. In this prospective, randomized controlled trial we show that a single (250 mL) bolus infusion of HSD in hemorrhagic trauma patients restores the balance between pro and antiinflammatory mediators in the early post-resuscitative period. Flow cytometric single-cell analyses revealed that, compared to standard resuscitation with NS, which selectively expands the proinflammatory CD14+CD16+ monocyte phenotype, initial treatment with HSD elicits selective depletion of CD14+CD16+ cells and down-regulates monocytic adhesion molecule expression. Moreover, HSD significantly inhibits intracellular TNF-a production by CD14+CD16+ monocytes, while upregulating both IL-10 and IL-1ra by CD14++CD16– monocytes. This differential profile of monocytic cytokine expression in response to HSD appears

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hemorrhagic shock, immune, cytokine, trauma, fluid resuscitation, hypertonic sal
Report Number
DRDC-TORONTO-SL-2004-099;RTO-MP-HFM-109 — Scientific Literature
Date of publication
16 Aug 2004
Number of Pages
Reprinted from
Published in NATO RTO-MP-HFM-109 proceedings, August 2004, Pages 1-1 to 1-24
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