Cardiovascular effects of hypertonic saline solution NaCl 7,5% [Greek]
Authors: Grosomanidis V, Fyntanidou B, Amaniti A, Chatsiou E, Karagkouni D, Fengoudaki M, Theodosiadis E, Ourailoglou V.
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Hypertonic solutions combined or not with colloids have been used successfully to restore intravascular volume and to enhance cardiovascular function. The aim of the present study was to investigate the hemodynamic effects of hypertonic saline solution administration in normovolemic patients.
Forty-five patients who underwent elective surgery were included in the study. After anesthesia induction, initiation of mechanical ventilation and fluid replacement of fasting deficit all patients received 4ml/kg NaCl 7,5% intravenously in the maximum possible infusion rate. Esophageal Doppler Monitoring (ODM II) was used in all patients to assess cardiac function throughout the study period. Measurements were obtained before NaCl 7,5% administration (Phase 1), after completion of NaCl 7,5% administration (Phase 2) and every 5 min thereafter for one hour (Phases 3 to 14). Furthermore, at Phases 1, 2 and 14 sodium plasma levels (Na), hemoglobin (Hb) and hematocrit (Hct) were also measured. Altogether recorded parameters included heart rate (HR), blood pressure (BP) (Systolic, Diastolic and Mean), cardiac output (CO), stroke volume (SV), peak velocity (PV), mean acceleration (MA), flow time corrected (FTc), Na, Hb and Hct.
At Phase 1 SV and CO were 62,4ml and 4l/min respectively. Both parameters increased and reached 100ml and 7,3l/min at Phase 2. Thereafter, SV and CO had gradually decreased and at the end of the study their values were 78ml και 5,2l/min respectively. PV increased from 57,7cm/sec (Phase 1) to 77,7cm/sec (Phase 2) and finally to 66 cm/sec at the end of the study (Phase 14). At Phase 1, MA and FTc were 5,7cm/sec2 and 0,4sec respectively, then both increased and reached 7,5cm/sec2 and 0,5sec respectively (Phase 2) and finally at Phase 14 their values were 6,1cm/sec2 and 0,5sec respectively. All before mentioned parameter values increased in a statistically significant manner after NaCl 7,5% administration compared to baseline measurements. The increase remained to be statistically significant throughout the study. HR increased from 64b/min before NaCl 7,5% administration to 74b/min after NaCl 7,5% administration but reached baseline values after 10min. BP (SBP, DBP and MBP) decreased from 118/64mmHg to 92/53mmHg and then reached rapidly baseline values.
NaCl 7,5% administration resulted in CO and SV increase and contributed to cardiac function enhancement. This beneficial impact remained statistically significant for 60min throughout the study period. Those positive effects can be attributed to the intravascular volume increase, the vascular resistance decrease and possibly to the enhancement of left heart contractility which are all caused by the hypertonic saline solution administration.