***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: Background The mucoactive effects of hypertonic saline should promote exacerbation resolution in people with cystic fibrosis ( CF ) . Objectives To determine the effects of hypertonic saline inhalation during hospitalisation for exacerbation of CF on length of stay , lung function , symptoms , oxygenation , exercise tolerance , quality of life , bacterial load and time to next hospitalisation . Methods 132 adults with an exacerbation of CF were r and omised to inhale three nebulised doses a day of either 4 mL 7 % saline or a taste-masked control of 0.12 % saline , throughout the hospital admission . The primary outcome measure was length of hospital stay . Results All participants tolerated their allocated saline solution . There was no significant difference in length of stay , which was 12 days in the hypertonic saline group and 13 days in controls , with a mean between-group difference ( MD ) of 1 day ( 95 % CI 0 to 2 ) . The likelihood of regaining pre-exacerbation FEV1 by discharge was significantly higher in the hypertonic saline group ( 75 % vs 57 % ) , and the number needed to treat was 6 ( 95 % CI 3 to 65 ) . On a 0–100 scale , the hypertonic saline group had significantly greater reduction in symptom severity than the control group at discharge in sleep ( MD=13 , 95 % CI 4 to 23 ) , congestion ( MD=10 , 95 % CI 3 to 18 ) and dyspnoea ( MD=8 , 95 % CI 1 to 16 ) . No significant difference in time to next hospitalisation for a pulmonary exacerbation was detected between groups ( HR=0.86 ( CI 0.57 to 1.30 ) , p=0.13 ) . Other outcomes did not significantly differ . Conclusions Addition of hypertonic saline to the management of a CF exacerbation did not reduce the length of hospital stay .  Hypertonic saline speeds the resolution of exacerbation symptoms and allows patients to leave hospital with greater symptom resolution . Trial registration number ACTRN12605000780651 Background The renal distal nephron plays an important role in the maintenance of sodium balance , extra cellular volume and blood pressure . The degree of water transport , via aquaporin2 water channels ( AQP2 ) , and sodium transport , via epithelial sodium channels ( ENaC ) in renal collecting duct principal cells are reflected by the level of urinary excretion of AQP2 ( u-AQP2 ) and the γ-fraction of ENaC ( u-ENaCγ ) . The effects of an acute intravenous volume load with isotonic saline , hypertonic saline and glucose on u-AQP2 , u-ENaCγ and underlying mechanisms have never been studied in a r and omized , placebo-controlled trial in healthy humans . Methods We studied the effects of 0.9 % saline ( 23 ml/kg ) , 3 % saline ( 7 ml/kg ) and 5 % glucose ( 23 ml/kg ) on u-AQP2 and u-ENaCγ , fractional sodium excretion ( FENa ) , free water clearance ( CH2O ) , and plasma concentrations of vasopressin ( AVP ) , renin ( PRC ) , angiotensin II ( ANG II ) and aldosterone ( Aldo ) in a r and omized , crossover study of 23 healthy subjects , who consumed a st and ardized diet , regarding calories , sodium and fluid for 4 days before each examination day . Results After isotonic saline infusion , u-AQP2 increased ( 27 % ) . CH2O and u-ENaCγ were unchanged , whereas FENa increased ( 123 % ) . After hypertonic saline infusion , there was an increase in u-AQP2 ( 25 % ) , u-ENaCγ ( 19 % ) and FENa ( 96 % ) , whereas CH2O decreased ( -153 % ) . After isotonic glucose infusion , there was a decrease in u-AQP2 ( -16 % ) , ENaCγ ( -10 % ) and FENa ( -44 % ) whereas CH2O increased ( 164 % ) . AVP remained unchanged after isotonic saline and glucose , but increased after hypertonic saline ( 139 % ) . PRC , AngII and p-Aldo decreased after isotonic and hypertonic saline infusion , but not after glucose infusion . Conclusions Volume expansion with 3 % and 0.9 % saline  increased u-AQP2 , while isotonic glucose decreased u-AQP2 . Infusion of hypertonic saline increased u-ENaCγ , whereas u-ENaCγ was not significantly changed after isotonic saline and tended to decrease after glucose . Thus , the transport of water and sodium is changed both via the aquaporin 2 water channels and the epithelial sodium channels during all three types of volume expansion to regulate and maintain water- and sodium homeostasis in the body . Trial registration Clinical Trial no : Successful resuscitation of the injured may be achieved more rapidly and with less fluid using hypertonic crystalloid solutions than with isotonic solutions . This r and omized , double-blind study compared 0.9 % normal saline ( NS ) to 1.8 % hypertonic saline ( HS ) in 20 postoperative coronary artery bypass patients suffering uniform injury . Study solutions were administered to maintain physiologic endpoints : heart rate , blood pressure , and pulmonary capillary wedge pressure . The groups were similar with respect to age , body surface area , operative procedure , intraoperative fluid status , and intraoperative and postoperative red cell transfusion requirements . HS patients required 30 % less fluid than NS patients and were in negative fluid balance during the study ( -1,715 + /- 732 ml/24 hr , HS , vs. + 266 + /- 825 ml/24 hr , NS ; p less than 0.01 ) . In contrast , NS patients were in positive fluid balance after 8 hours . Moreover , HS patients experienced less chest tube drainage than NS patients ( 981 + /- 88 ml , HS , vs. 1,700 + /- 285 ml , NS ; p less than 0.01 ) . Systemic and pulmonary hemodynamic measurements , oxygen delivery , oxygen consumption , and shunt fraction did not differ between the two groups . Serum sodium and osmolality increased in the HS group and peaked at 12 hours ( 145.4 + /- 1.4 mEq/L and 308.7 + /- 2.0 mOsm/kg , respectively ) and correlated with the volume of HS infused ( correlation coefficient = 0.81 ) . No deaths occurred and no complication was attributed the hypertonicity of the solution . We conclude that 1.8 % hypertonic saline is a safe alternative to isotonic crystalloid therapy in the fluid management of postoperative patients . Decreased third-space losses may occur with HS as suggested by the lower thoracic losses in the HS group ; 1.8 % NaCl may be the preferred solution in situations where excess free water administration is not desired , and where interstitial edema is detrimental to function and /or survival Background The use of hypertonic crystalloid solutions , including sodium chloride and bicarbonate , for treating severe sepsis has been much debated in previous investigations . We have investigated the effects of three crystalloid solutions on fluid resuscitation in severe sepsis patients with hypotension . Methods Ninety-four severe sepsis patients with hypotension were r and omly assigned to three groups . The patients received the following injections within 15 min at initial treatment : Ns group ( n = 32 ) , 5 ml/kg normal saline ; Hs group ( n = 30 ) , with 5 ml/kg 3.5 % sodium chloride ; and Sb group ( n = 32 ) , 5 ml/kg 5 % sodium bicarbonate .  Cardiac output ( CO ) , systolic blood pressure , mean arterial pressure ( MAP ) , body temperature , heart rate , respiratory rate and blood gases were measured . Results There were no differences among the three groups in CO , MAP , heart rate or respiratory rate during the 120 min trial or the 8 hour follow-up , and no significant differences in observed mortality rate after 28 days . However , improvement of MAP and CO started earlier in the Sb group than in the Ns and Hs groups . Sodium bicarbonate increased the base excess but did not alter blood pH , lactic acid or [HCO3]- values ; and neither 3.5 % hypertonic saline nor 5 % sodium bicarbonate altered the Na+ , K+ , Ca2 + or Cl- levels . Conclusion All three crystalloid solutions may be used for initial volume loading in severe sepsis , and sodium bicarbonate confers a limited benefit on humans with severe sepsis . Trial registration IS RCT N36748319 Introduction Positive fluid balance has been associated with an increased risk for mortality in critically ill patients with acute kidney injury with or without renal replacement therapy ( RRT ) . Data on fluid accumulation prior to RRT initiation and mortality are limited . We aim ed to study the association between fluid accumulation at RRT initiation and 90-day mortality . Methods We conducted a prospect i ve , multicenter , observational cohort study in 17 Finnish intensive care units ( ICUs ) during a five-month period . We collected data on patient characteristics , RRT timing , and parameters at RRT initiation . We studied the association of parameters at RRT initiation , including fluid overload ( defined as cumulative fluid accumulation > 10 % of baseline weight ) with 90-day mortality . Results We included 296 RRT-treated critically ill patients . Of 283 patients with complete data on fluid balance , 76 ( 26.9 % ) patients had fluid overload . The median ( interquartile range ) time from ICU admission to RRT initiation was 14 ( 3.3 to 41.5 ) hours . The 90-day mortality rate of the whole cohort was 116 of 296 ( 39.2 % ; 95 % confidence interval 38.6 to 39.8 % ) . The crude 90-day mortality of patients with or without fluid overload was 45 of 76 ( 59.2 % ) vs. 65 of 207 ( 31.4 % ) , P < 0.001 . In logistic regression , fluid overload was associated with an increased risk for 90-day mortality ( odds ratio 2.6 ) after adjusting for disease severity , time of RRT initiation , initial RRT modality , and sepsis . Of the 168 survivors with data on RRT use at 90 days , 34 ( 18.9 % , 95 % CI 13.2 to 24.6 % ) were still dependent on RRT . Conclusions Patients with fluid overload at RRT initiation had twice as high crude 90-day mortality compared to those without . Fluid overload was associated with increased risk for 90-day mortality even after adjustments Background The previously published “ Dose Response Multicentre International Collaborative Initiative ( DoReMi ) ” study concluded that the high mortality of critically ill patients with acute kidney injury ( AKI ) was unlikely to be related to an inadequate dose of renal replacement therapy ( RRT ) and other factors were contributing . This follow-up study aim ed to investigate the impact of daily fluid balance and fluid accumulation on mortality of critically ill patients without AKI ( N-AKI ) , with AKI ( AKI ) and with AKI on RRT ( AKI-RRT ) receiving an adequate dose of RRT . Methods We prospect ively enrolled all consecutive patients admitted to 21 intensive care units ( ICUs ) from nine countries and collected baseline characteristics , comorbidities , severity of illness , presence of sepsis , daily physiologic parameters and fluid intake-output , AKI stage , need for RRT and survival status .  Daily fluid balance was computed and fluid overload ( FO ) was defined as percentage of admission body weight ( BW ) . Maximum fluid overload ( MFO ) was the peak value of FO . Results We analysed 1734 patients . A total of 991 ( 57 % ) had N-AKI , 560 ( 32 % ) had AKI but did not have RRT and 183 ( 11 % ) had AKI-RRT .  ICU mortality was 22.3 % in AKI patients and 5.6 % in those without AKI ( p < 0.0001 ) . Progressive fluid accumulation was seen in all three groups . Maximum fluid accumulation occurred on day 2 in N-AKI patients ( 2.8 % of BW ) , on day 3 in AKI patients not receiving RRT ( 4.3 % of BW ) and on day 5 in AKI-RRT patients ( 7.9 % of BW ) . The main findings were : ( 1 ) the odds ratio ( OR ) for hospital mortality increased by 1.075 ( 95 % confidence interval 1.055–1.095 ) with every 1 % increase of MFO . When adjusting for severity of illness and AKI status , the OR changed to 1.044 . This phenomenon was a continuum and independent of thresholds as previously reported . ( 2 ) Multivariate analysis confirmed that the speed of fluid accumulation was independently associated with ICU mortality . ( 3 ) Fluid accumulation increased significantly in the 3-day period prior to the diagnosis of AKI and peaked 3 days later . Conclusions In critically ill patients , the severity and speed 
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Conclusion : Fluid resuscitation using hypertonic saline results in volume expansion and less total infusion volume .
This may be of interest in oedematous patients with intravascular volume depletion .
When such strategies are employed , renal effects may differ markedly according to prior intravascular volume status .
Hypertonic saline induced changes in serum osmolality and electrolytes return to baseline within a limited period in time .
Sparse evidence indicates that resuscitation with hypertonic saline results in less perioperative complications , ICU days and mortality in selected patients .
In conclusion , the use of hypertonic saline may have beneficial features in selected critically ill patients when carefully chosen .
HighlightsFluid resuscitation using hypertonic saline results in volume expansion with less total infusion volume .
This may be of particular interest in patients with intravascular volume depletion and advanced tissue edema .
Renal effects after administration of hypertonic saline may differ markedly according to prior volume statusChanges in serum osmolality and electrolytes are only temporary .
Resuscitation with hypertonic saline may result in reduced perioperative complications , ICU days and mortality in selected patients