Initial treatment of shock

Abstract

The aim of this project is to study hypertonic saline solutions (HSS) and oxygen-carrying blood substitutes in the initial management of shock, given that these could elicit hemodynamic, microcirculatory, and cellular benefits capable of reducing the prevalent high post-traumatic mortality rates. Trauma is one of the major world public health problems, being the first cause of mortality for ages between one and 40 years old. Post-traumatic deaths are distributed in three peaks as a function of time. About 50% of these deaths are instantaneous. Virtually nothing can be done for these patients. The second peak of post-traumatic deaths occurs minutes or during the first hours following severe trauma, mainly as a consequence of hemorrhagic shock. Optimal and efficacious initial treatment can substantially reduce these deaths. The third peak is observed weeks after the initial treatment, caused by multiple organs or systems dysfunction and failure, directly related to the speed and efficacy of initial treatment. Therefore post-traumatic shock treatment is the critical determinant factor for reduction of early and late preventable trauma related mortality. Small volumes of hypertonic sodium chloride (7.5% NACI) restore blood pressure, cardiac output, and regional blood flows when injected to animals in severe hemorrhagic shock. In clinical studies of post-traumatic hypotension, benefits were also observed with the use of hypertonic saline solutions, principally for trauma victims requiring surgery for head injury patients with systemic hypotension. Despite extensive laboratorial investigation and considerable clinical experience with hypertonic saline solutions, important clinical aspects remain to be clarified as well as controversies that will be evaluated in this project. (AU)