7 Hyperosmotic-hyperoncotic solutions

Since the first descriptions of the use of 7.5% hypertonic saline for resuscitation of haemorrhage in 1980, there has been substantial animal research and clinical evaluation of small volume resuscitation. Most interest has focused on combined hyperosmotic and hyperoncotic colloid formulations. Infused hyperosmotic NaCl rapidly expands plasma volume, while the hyperoncotic colloid sustains the volume expansion. Other contributing factors to the efficacy of these solutions are increased cardiac effectiveness and peripheral vasodilation. The most often studied solution, 7.5% NaCl/6% dextran 70, offers promise to reduce the mortality of traumatic hypotension and head injury when used as an initial treatment. Future hyperosmotic-hyperoncotic formulations with different solutes may provide specific beneficial pharmacological properties in addition to the established cardiovascular effects of hyperosmolarity. A particularly promising formulation might be a combination solution of an oxygen carrier colloid, for example, haemoglobin, and a hyperosmotic crystalloid.