Hypertonic volume therapy
feasibility in the prevention and treatment of multiple organ failure and sepsis
Palavras-chave:
Sepsis, Multiple organ failure, Hypertonic solution, ShockResumo
INTRODUÇÃO: As soluções salinas hipertônicas em pequeno volume, aplicadas em "bolo", empregaram-se originalmente no tratamento do choque hemorrágico e traumático grave, demonstrando a rápida restauração hemodinâmica e do fluxo sangüíneo orgânico regional. Os mecanismos de ação são diversos - 1. manutenção do débito cardíaco elevado (estímulo direto do miocárdio; aumento do volume intravascular); 2. manutenção da vasodilatação arterial periférica (efeito da hiperosmolaridade; aumento do volume plasmático); 3. redução do edema tecidual (fluxo de líquido do interstício decorrente do gradiente osmótico). Estes eventos promovem a recuperação da acentuada alteração na microcirculação, que freqüentemente são também observadas na sepse. MATERIAL E MÉTODOS: O uso destas soluções tem sido objeto de vários estudos em modelos experimentais de endotoxemia hiperdinâmica aguda, entretanto, um maior número de estudos clínicos são necessários para melhor compreensão dos efeitos positivos, ou eventualmente deletérios, da utilização das soluções cristalóides hipertônicas em pequeno volume na terapêutica da sepse e falência de múltiplos orgãos. OBJETIVO: O objetivo deste artigo é analisar o conceito do uso de soluções hipertônicas e o seu potencial no tratamento da intensa hipovolemia e deterioração da microcirculação, que ocorre na sepse e no choque endotóxico.
Downloads
Referências
ARMISTEAD, C.W.; VINCENT, J.L.; PREISER, J.C.; DEBACKER, D. & MINH, T.L. - Hypertonic saline solution-hetastarch for fluid resuscitation in experimental septic shock. Anesth Analg 69:714-720, 1989.
BAKER, C.C. - Epidemiology of trauma: the civilian perspective. Ann Emerg Med 15:1389-1390, 1986.
BAKER, J.W.; DEITCH, E.A.; LI, M.; BERG, R.D. & SPECIAN, R.D. - Hemorrhagic shock induces bacterial translocation from the gut. J Trauma 28:896-906, 1988.
BAYER, M.; NOLTE, D.; LEHR, H.A.; KREIMEIER, U. & MESSMER, K. - Hypertonic-hyperoncotic dextran solution reduces postischemic leukocyte adherence in postcapillary venules. Langenbecks Arch Chir (Suppl) 375-378, 1991.
BIHARI, D.J. - Mismatch of the oxygen supply and demand in septic shock In: Vincent JL, Thijs LG (eds) Septic shock Springer Berlin, pp 143-160 (Update in Intensive Care and Emergency Medicine Vol 4), 1987.
BIHARI, D.J. - Multiple organ failure: role of tissue hypoxia. In: Bihari DJ, Cerra FB (eds) Multiple Organ Failure Society of Critical Care Medicine, Fullerton, pp 25-36, 1989.
BONE, R.C.; FISHER, C.J.; CLEMMER, T.P.; SLOTMAN, G.J.; METZ, C.A. & BALK, R.A. - The methylprednisolone severe sepsis study group Sepsis syndrome: a valid clinical entity. Crit Care Med 17:389-393, 1989.
BORDER, J.R.; HASSETT, J.; LaDUCA, J.; SEIBEL, R.; STEINBERG, S.; MILLS, B.; LOSI, P. & BORDE, D. - The gut origin septic states in blunt multiple trauma (ISS=40) in the ICU. Ann Surg 206:427-448, 1987.
BRIGHAM, K.L. & MEYRICK, B. - Endotoxin and lung injury. State of the art. Am Rev Respir Dis 133:913-927, 1986.
BRONSVELD, W.; VAN LAMBALGEN, A.A.; VAN DEN BOS, G.C.; THIJS, L.G. & KOOPMAN, P.A. - Effects of glucose-insulin-potassium (GIK) on myocardial blood flow and metabolism in canine endotoxin shock. Circ Shock 13:325-340, 1984.
BRUTTIG, S.P.; DISCHER, D.; DOHERTY, T.J.; BORGSTROEM, P. & ARFORS, K.E. - Hypertonic saline dextran (HSD) improves peripheral microvascular performance following massive uncontrolled hermorrhage. Circ Shock 34:36, 1991.
CARMONA, R.; CATALANO, R. & TRUNKEY, D.D. - Septic shock. In: Shires GT (ed) Shock and related problems Churchill Livingstone, Edinburg, pp 156-177, 1984.
CARRICO, C.J.; MEAKINS, J.L.; MARSHALL, J.C.; FRY, D. & MAIER, R.V. - Multiple organ-failure syndrome. Arch Surg 121:196-208, 1986.
CHAUDRY, I.H.; AYALA, A.; ERTEL, W. & STEPHAN, R.N. - Hemorrhage and resuscitation: immunological aspects (editorial review). Am J Physiol 259:R663-R678, 1990.
DE FELIPPE, J. Jr.; TIMONER, J.; VELASCO, I.T. & LOPES, O.U. - Treatment of refractory hypovolaemic shock by 7.5% sodium chloride injections. Lancet ii:1002-1004, 1980.
DEITCH, E.A.; BRIDGES, W.; MA, L.; BERG, R.; SPECIAN, R.D. & GRANGER, D.N. - Hemorrhagic shock-induced bacterial translocation: the role of neutrophils and hydroxyl radicals. J Trauma 30:942-952, 1990.
FONG, Y.; MOLDAWER, L.L.; SHIRES, G.T. & LOWRY, S.F. - The biological characteristics of cytokines and their implication in surgical injury. Surg Gynecol Obstet 170:363-378, 1990.
FREY, L.; KREIMEIER, U.; PACHECO, A. & MESSMER, K. - Effect of 7.2% saline/10% dextran-60 vs. 7.2% saline/ 10% hydroxyethylstarch on macro and microhemodynamics in traumatic-hemorrhagic hypotension. Eur Surg Res 22:297 (Abstract), 1990.
GRANGER, D.N.; RUTILI, G. & McCORD, J.M. - Superoxide radicals in feline intestinal ischemia. Gastroenterology 81:22-29, 1981.
GRANGER, D.N.; BENOIT, J.N.; SUZUKI, M. & GRISHAM, M.B. - Leukocyte adherence to venular endothelium during ischemia-reperfusion. Am J Physiol 20:G683-G688, 1989.
HACK, C.E. & THIJS, L.G. - The orchestra of mediators in the pathogenesis of septic shock. In: Vincent JL (ed) Update in Intensive Care and Emergency Medicine Update 1991. Springer, Berlin Heidelberg New York, pp 233-241, 1991.
HOLCROFT, J.W.; VASSAR, M.J.; TURNER, J.E.; DERLET, R.W. & KRAMER, G.C. - 3% NaCI and 7.5% NaCI/Dextran 70 in the resuscitation of severely-injured patients. Ann Surg 206:279-286, 1987.
HOLCROFT, J.W.; WASSAR, M.J.; PERRY, C.A.; GANNAWAY, W.L. & KRAMER, G.C. - Perspective on clinical trials for hypertonic saline/dextran solutions for the treatment of traumatic shock. Braz J Med Biol Res 22:291-293, 1989.
KRAMER, G.C.; PERRON, P.R.; LINDSEY, D.C.; HO, H.S.; GUNTHER, R.A.; BOYLE, W.A. & HOLCROFT, J.W. - Small-volume resuscitation with hypertonic saline dextran solution. Surgery 100:239-247, 1986.
KRAMER, G.C.; ENGLISH, T.P.; GUNTHER, R.A. & HOLCROFT, J.W. - Physiological mechanisms of fluid resuscitation with hyperosmotic hyperoncotic solutions. In: Passmore JC, Reichard SM Reynold DG, Traber DL (eds) Perspectives in Shock Research, Metabolism, Immunonology, Mediators and Models Alan R Liss, New York, pp 311-320, 1989.
KREIMEIER, U. & FREY, L. - Schock. In: Hierholzer K, Schmidt RF (eds) Pathophysiologie des Menschen VCH. Winheim, pp 1735-1745, 1991.
KREIMEIER, U. & MESSMER, K. - Small-volume resuscitation. In: Kox WJ, Gamble J (eds) Fluid resuscitation. Bailliere's Clinical Anaesthesiology, vol 2. Bailliere Tindall, London, pp 545-577, 1988.
KREIMEIER, U.; YANG, Z. & MESSMER, K. - The role of fluid replacement in acute endotoxin shock. In: Kox W, Bihari D (eds) Shock and the adult respiratory distress syndrome Springer, Berlin, pp 179-190, 1988.
KREIMEIER, U.; BRÜCKNER, U.B. & NIEMCZYK, S. - Hyperosmotic saline dextran for resuscitation from traumatic-hemorrhagic hypotension: effect on regional blood flow. Circ Shock 32:83-99, 1990.
KREIMEIER, U.; BRÜCKNER, U.B.; SCHMIDT, J. & MESSMER, K. - Instantaneous restoration of regional organ blood flow after severe hemorrhage: effect of small-volume resuscitation with hypertonic-hyperoncotic solutions. J Surg Res 49:493-503, 1990.
KREIMEIER, U.; FREY, L.; DENTZ, J.; HERBEL, T. & MESSMER, K. - Hypertonic saline dextran resuscitation during the initial phase of acute endotoxemia: effect on regional blood flow. Crit Care Med 19:801-809, 1991.
KVIETYS, P.R. & GRANGER, D.N. - Hypoxia: its role in ischemic injury to the intestinal mucosa. In: Marston A, Bulkley GB, Fiddian-Green RG, Haglund UH (eds) Splanchnic ischemia and multiple organ failure Arnold, London, pp 127-134, 1989.
MANINGAS, RA. - Resuscitation with 7.5% NaCI in 6% dextran-70 during hemorrhagic shock in swine: effects on organ blood flow. Crit Care Med 15:1121-1126, 1987.
MANINGAS, RA.; DE GUZMAN, L.R.; TILLMAN, F.J.; HINSON, C.S.; PRIEGNITZ, K.J.; VOLK, K.A. & BELLAMY, R.F. - Small-volume infusion of 7.5% NaCI in 6% Dextran 70 for the treatment of severe hemorrhagic shock in swine. Ann Emerg Med 15: 1131-1137, 1986.
MANINGAS, RA.; MATTOX, K.L.; PEPE, P.E.; JONES, R.L.; FELICIANO, D.V. & BURCH, J.M. - Hypertonic saline-dextran solutions for the prehospital management of traumatic hypotension. Am J Surg 157:528-534, 1989.
MARTI-CABRERA, M.; ORTIZ, J.L.; DURA, J.M.; CORTIJO, J.; BARRACHINA, M.D. & MORCILLO, E. - Hemodynamics effects of hyperosmotic mannitol infusion in anaesthetized open-chest dogs: modification by cyclooxygenase inhibition. Res Surg 3:29-33, 1991.
MATTOX, K.L.; MANINGAS, P.A.; MOORE, E.E.; MATEER, J.R.; MARX, J.A.; APRAHAMIAN, C.; BURCH, J.M. & PEPE, P.E. - Prehospital hypertonic saline dextran infusion for post-traumatic hypotension - the USA multicenter trial. Ann Surg 213: 482-491, 1991.
MAZZONI, M.C.; BORGSTROEM, P.; ARFORS, K.E. & INTAGLIETTA, M. - Dynamic fluid redistribution in hyperosmotic resuscitation of hypovolemic hemorrhage. Am J Physiol 255:H629-H637, 1988.
MAZZONI, M.C.; BORGSTROEM, P.; INTAGLIETTA, M. & ARFORS, K.E. - Capillary narrowing in hemorrhagic shock is rectified by hyperosmotic saline-dextran reinfusion. Circ Shock 31:407-418, 1990.
McCABE, C.J. - Trauma: an annotated bibliography of the recent literature. Am J Emerg Med 8:446-463, 1990.
MESSMER, K.F.W. - Mechanisms of traumatic shock and their consequences. In: Border JR, Allgöwer M, Hansen ST, Jr., Rüedi TP (eds) Blunt multiple trauma - comprehensive pathophysiology and care Dekker, New York, pp 39-49, 1990.
MESSMER, K.; KREIMEIER, U. & HAMMERSEN, F. - Multiple organ failure: clinical implications to macro - and microcirculation. In: Manabe H, Zeifach BW, Messmer K (eds) Microcirculation in circulatory disorders. Springer, Berlin, pp 147-157, 1988.
MICHIE, H.R.; MANOGUE, K.R.; SPRIGGS, D.R.; REVHAUG, A.; O'DWYER, S.; DINARELLO, C.A.; GERAMI, A.; WOLF, S.M. & WILMORE, D.W. - Detection of circulating tumor necrosis factor after endotoxin administration. N Engl J Med 318:1481-1486, 1988.
MULLINS, R.J. & HUDGENS, R.W. - Hypertonic saline resuscitates dogs in endotoxin shock. J Surg Res 43:37-44, 1987.
NAKAYAMA, S.; SIBLEY, L.; GUNTHER, R.A.; HOLCROFT, J.W. & KRAMER, G.C. - Small-volume resuscitation with hypertonic saline (2,400 mosm/liter) during hemorrhagic shock. Circ Shock 13:149-159, 1984.
NAKAYAMA, S.; KRAMER, G.C.; CARLSEN, R.C. & HOLCROFT, J.W. - Infusion of very hypertonic saline to bled rats. Membrane potentials and fluid shifts. J Surg Res 38:180-186, 1985.
PROUGH, D.S.; WHITLEY, J.M.; TAYLOR, C.L.; DEAL, D.D. & DeWITT, D.S. - Small-volume resuscitation from hemorrhagic shock in dogs: effects on systemic hemodynamics and systemic blood flow. Crit Care Med 19:364-372, 1991.
SHOEMAKER, W.C. - Hemodynamic and oxygen transport patterns in septic shock: physiologic mechanisms and therapeutic implications. In: Sibbald WJ, Sprung CL (eds) Perspectives on sepsis and septic shock Society of Critical Care Medicine, Fullerton, pp 203-234, 1986.
SMITH, G.J.; KRAMER, G.C.; PERRON, P.; NAKAYAMA, S.; GUNTHER, R.A. & HOLCROFT, J.W. - A comparison of several hypertonic solutions for resuscitation of bled sheep. J Surg Res 39:517-528, 1985.
THIJS, L.G. & GROENEVELD, A.B.J. - The circulatory defect of septic shock. In: Vincent JL, Thijs LG (eds) Septic shock Springer, Berlin Heidelberg New York, pp 161-178 (Update in Intensive Care and Emergency Medicine, vol 4), 1987.
TRUNKEY, D.D. - Trauma. Sci Am 249:20-27, 1983.
VELASCO, I.T.; PONTIERI, V.; ROCHA e SILVA, R.M.Jr. & LOPES, O.U. - Hyperosmotic NaCl and severe hemorrhagic shock. Am J Physiol 239:664-673, 1990.
VELASCO, I.T.; OLIVEIRA, M.A. & ROCHA e SILVA, M. - A comparison of hyperosmotic and hyperoncotic resuscitation from severe hemorrhagic shock in dogs. Circ Shock 21:338, 1987.
Downloads
Publicado
Como Citar
Edição
Seção
Licença
Este trabalho está licenciado sob uma licença Creative Commons Attribution 4.0 International License.
