Loftus TJ, et al. - Researchers aimed to verify the safety of 3% hypertonic saline (HTS) resuscitation for trauma and acute care surgery patients undergoing emergent laparotomy and temporary abdominal closure (TAC) with the hypothesis that HTS administration would be associated with hyperosmolar hypercholoremic acidosis, lower resuscitation volumes, and higher fascial closure rates, without adversely affecting renal function. In this study, hypertonic saline resuscitation was observed to be associated with the development of a hypernatremic, hyperchloremic, hyperosmolar acidosis, and lower total IVF resuscitation volumes, without adversely affecting renal function. They realized that these findings could not be generalizable to patients with baseline renal dysfunction and susceptibility to hyperchloremic acidosis-induced kidney injury.

Methods

• A retrospective cohort analysis was performed of 189 trauma and acute care surgery patients who underwent emergent laparotomy and TAC,
• Researchers compared patients with normal baseline renal function who received 3% HTS at 30 mL/h (n = 36) to patients with standard resuscitation (n = 153) by baseline characteristics, resuscitation parameters, and outcomes.
• Outcomes included primary fascial closure and Kidney Disease: Improving Global Outcomes stages of acute kidney injury.

Results

• Similar baseline illness severity and organ dysfunction were observed between the HTS and standard resuscitation groups, though HTS patients had lower serum creatinine at initial laparotomy (1.2 mg/dL vs 1.4 mg/dL; p = 0.078).
• HTS patients showed markedly higher serum sodium (145.8 mEq/L vs 142.2 mEq/L, p < 0.001), chloride (111.8 mEq/L vs 106.6 mEq/L, p < 0.001), and osmolarity (305.8 mOsm/kg vs 299.4 mOsm/kg; p = 0.006), and markedly lower arterial pH (7.34 vs 7.38; p=0.011) 48 hours after TAC.
• Within 48 hours of TAC, the HTS patients showed lower intravenous fluid (IVF) volumes (8.5 L vs 11.8 L; p=0.004).
• The groups were similar in terms of serum creatinine, urine output, and kidney injury.
• Researchers achieved fascial closure for 92% of all HTS patients and 77% of all standard resuscitation patients (p=0.063).
• Higher IVF resuscitation volumes within 48 hours of TAC were associated with decreased odds of fascial closure considering all 189 patients (odds ratio, 0.90; 95% confidence interval, 0.83–0.97; p=0.003).