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Patients with acute decompensated heart failure (ADHF) have high rates of mortality and morbidity despite recent improvements in diagnosis and treatment. Still patients with significant heart failure and especially with NYHA class III -IV HF and low blood pressure with or without hyponatremia and renal failure are considered severe patients with reduced response to standard treatment with high mortality rates and high re-hospitalizations as they are associated with worse prognosis. Several works and meta -analysis have shown the importance and benefit of treatment with the infusion of hypertonic saline solution (HSS) in these patients and in different conditions of cardiovascular collapse. Current evidence indicates that the infusion of hypertonic solution in heart failure patients can provide clinical and hemodynamic improvement. The investigators are testing the hypothesis that the infusion of hypertonic solution in association with diuretics may prevent the occurrence of renal dysfunction in patients with ADHF and can reduced the re-hospitalizations rate. Our experience in treating several patients has been successful and has shown significant improvement in symptoms and weight loss and improvement in renal function, due to the small size of the sample we were unable to perform a controlled study. We hypothesize that HSS, treatment should be adopted practically and a treatment protocol should be built in patients with intractable ADHF, especially with hypotension, hyponatremia with/without renal failure and overloaded.

The Potential Therapeutic Effect of Hypertonic Saline Solution (HSS) for the Management of Refractory Acute Decompensated Heart Failure (ADHF)