Hypertonic saline infusion does not improve the chance of primary fascial closure after damage control laparotomy : a randomized controlled trial
García, Alberto (Universidad del Valle)
Manzano-Nuñez, Ramiro (Hospital Universitari Vall d'Hebron)
Carrillo, Diana Cristina (Fundación Valle del Lili)
Chica-Yanten, Julian (Fundación Valle del Lili)
Naranjo, María Paula (Universidad Sanitas)
Sánchez, Álvaro I. (Fundación Valle del Lili)
Mejía, Jorge Humberto (Fundación Valle del Lili)
Ospina-Tascón, Gustavo Adolfo (Universidad Icesi)
Ordoñez, Carlos A. (Universidad del Valle)
Bayona, Juan Gabriel (Universidad Javeriana)
Puyana, Juan Carlos (University of Pittsburgh)
Universitat Autònoma de Barcelona

Fecha:	2023
Resumen:	Previous observational studies showed higher rates of abdominal wall closure with the use of hypertonic saline in trauma patients with abdominal injuries. However, no randomized controlled trials have been performed on this matter. This double-blind randomized clinical trial assessed the effect of 3% hypertonic saline (HS) solution on primary fascial closure and the timing of abdominal wall closure among patients who underwent damage control laparotomy for bleeding control. Double-blind randomized clinical trial. Patients with abdominal injuries requiring damage control laparotomy (DCL) were randomly allocated to receive a 72-h infusion (rate: 50 mL/h) of 3% HS or 0. 9 N isotonic saline (NS) after the index DCL. The primary endpoint was the proportion of patients with abdominal wall closure in the first seven days after the index DCL. The study was suspended in the first interim analysis because of futility. A total of 52 patients were included. Of these, 27 and 25 were randomly allocated to NS and HS, respectively. There were no significant differences in the rates of abdominal wall closure between groups (HS: 19 [79. 2%] vs. NS: 17 [70. 8%]; p = 0. 71). In contrast, significantly higher hypernatremia rates were observed in the HS group (HS: 11 [44%] vs. NS: 1 [3. 7%]; p < 0. 001). This double-blind randomized clinical trial showed no benefit of HS solution in primary fascial closure rates. Patients randomized to HS had higher sodium concentrations after the first day and were more likely to present hypernatremia. We do not recommend using HS in patients undergoing damage control laparotomy. Trial registration The trial protocol was registered in clinicaltrials. gov (identifier: NCT02542241).
Derechos:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.
Lengua:	Anglès
Documento:	Article ; recerca ; Versió publicada
Materia:	Abdominal injuries ; Damage control surgery ; Hypertonic saline ; Trauma and injuries
Publicado en:	World Journal of Emergency Surgery : WJES, Vol. 18 (january 2023) , ISSN 1749-7922

DOI: 10.1186/s13017-023-00475-x
PMID: 36624448

10 p, 1.1 MB

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