The incidence of septic shock has increased during the past several decades, whereas mortality rates have remained constant or have decreased slightly [1
]. Septic shock is associated with high mortality rates of 30–80% [1
]. Sepsis presents with a systemic inflammatory response, peripheral vasodilatation, myocardial depression, intravascular volume depression, and increased metabolism. Despite considerable knowledge of the pathophysiology of the systemic inflammatory response syndrome, clinical trials using interventions such as immunotherapy have yielded negative results [2
]. Global tissue hypoxia results in an imbalance between systemic oxygen delivery and demand, and is a key development preceding multiple organ failure and death [2
]. Rivers and colleagues [2
] demonstrated the importance of goal-directed therapy in septic shock and severe sepsis. An early resuscitation strategy, which was goal oriented with respect to manipulation of cardiac preload, afterload and contractility, reduced the incidence of multiple organ dysfunction and mortality.
Hemodynamic management in severe sepsis and septic shock includes rapid restoration of intravascular volume and adequate balance between systemic oxygen delivery and demand. Several liters of fluids (crystalloids or colloids) are usually necessary to normalize preload and filling pressures, with the objective of establishing adequate tissue perfusion and oxygen delivery [2
]. The infusion of several liters of fluid is associated with the adverse effect of extravasation into the interstitial space. In sepsis in particular, this may result in pulmonary edema. Nevertheless, adequate volume repletion with hemodynamic normalization may not be sufficient to prevent persistent microcirculatory dysfunction, which may cause ischemia and tissue damage [2
The observation reported by Velasco and colleagues in 1980 [6
] of beneficial effects of 7.5% saline solutions in dogs with severe hemorrhagic shock attracted interest to this field. The short duration of the circulatory effects of hypertonic saline solution (HSS) has been attributed to a rapid equilibrium of the hyperosmotic solute between extracellular and intra-cellular compartments. Therefore, HSS has been combined with colloids (i.e. dextran or hetastarch) in order to achieve a longer intravascular effect. This combination has synergistic effects, by increasing plasma osmolarity and osmotic pressure [7
]. Since the 1980s, several studies have been performed that used small volume resuscitation [6
], which is defined as a rapid infusion of HSS (NaCl 7.2–7.5%), in combination with dextran or hetastarch, at a dose of 4 ml/kg into a peripheral vein [6
]. Recent studies have used HSS in the treatment of sepsis [14
] and have demonstrated some promising beneficial effects.