Hypertonic saline versus mannitol for the treatment of increased intracranial pressure in traumatic brain injury

2019 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Taylor DeNett, ◽  
Cassandra Feltner,
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Intracranial Pressure ◽  
Hypertonic Saline ◽  
Increased Intracranial Pressure

scholarly journals Traumatic Brain Injury: Bolus Versus Continuous Infusion of 3% Hypertonic Saline

2016 ◽  
Vol 101 (7-8) ◽  
pp. 361-366
Author(s):  
David Parizh ◽  
Ilya Parizh ◽  
Caitlyn Kuwata ◽  
Galina Glinik ◽  
Anthony Kopatsis
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Intracranial Pressure ◽  
Continuous Infusion ◽  
Hypertonic Saline ◽  
Serum Sodium ◽  
Increased Intracranial Pressure ◽  
Significant Difference ◽  
Route Of Delivery ◽  
Neurosurgical Intervention

Hypertonic saline (HTS) is used as an adjunct in the conservative management of increased intracranial pressure; however, the ideal concentration or route of delivery is unknown. Our objective was to assess whether there is a difference in route of delivery, bolus versus infusion, of 2% versus 3% HTS in patients with traumatic brain injury. The study comprises a retrospective analysis of all patients who sustained traumatic brain injury resulting in increased intracranial pressure that required HTS from January 2012 to December 2014. We examined time to therapeutic serum sodium concentration greater or equal to 150 mEq; incidence of ventriculostomy placement and neurosurgical intervention for refractory intracanial hypertension; and disability burden among the different infusates and route of delivery. A total of 169 patients received either 2% or 3% HTS, given as a bolus or continuous infusion. Patients had an average age of 61.4 years; 100 patients (59.2%) were male and 69 (40.8%) were female; 62 patients were taking either an antiplatelet or anticoagulant agent. Infusion of 3% saline was associated with the shortest interval to reaching a therapeutic level at 1.61 days (P = 0.024). There was no statistically significant difference between placement of a ventriculostomy among the bolus and infusion groups of 3% normal saline (NS) (P = 0.475). However, neurosurgical intervention was less prevalent in those receiving 3% infusion (P = 0.013). Infusion of 3% HTS was associated with a more rapid increase in serum sodium to therapeutic levels. Neurosurgical intervention for refractory hypertension was less prevalent in the 3% NS infusion group.

Effects of hypertonic saline on intracranial pressure and cerebral autoregulation in pediatric traumatic brain injury

2021 ◽  
pp. 1-7
Author(s):  
Julian Zipfel ◽  
Juliane Engel ◽  
Konstantin Hockel ◽  
Ellen Heimberg ◽  
Martin U. Schuhmann ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Intracranial Pressure ◽  
Hypertonic Saline ◽  
Pediatric Patients ◽  
Injury Severity ◽  
Primary Outcome Measure ◽  
Favorable Outcome ◽  
Outcome Group ◽  
Significant Difference

OBJECTIVE Hypertonic saline (HTS) is commonly used in children to lower intracranial pressure (ICP) after severe traumatic brain injury (sTBI). While ICP and cerebral perfusion pressure (CPP) correlate moderately to TBI outcome, indices of cerebrovascular autoregulation enhance the correlation of neuromonitoring data to neurological outcome. In this study, the authors sought to investigate the effect of HTS administration on ICP, CPP, and autoregulation in pediatric patients with sTBI. METHODS Twenty-eight pediatric patients with sTBI who were intubated and sedated were included. Blood pressure and ICP were actively managed according to the autoregulation index PRx (pressure relativity index to determine and maintain an optimal CPP [CPPopt]). In cases in which ICP was continuously > 20 mm Hg despite all other measures to decrease it, an infusion of 3% HTS was administered. The monitoring data of the first 6 hours after HTS administration were analyzed. The Glasgow Outcome Scale (GOS) score at the 3-month follow-up was used as the primary outcome measure, and patients were dichotomized into favorable (GOS score 4 or 5) and unfavorable (GOS score 1–3) groups. RESULTS The mean dose of HTS was 40 ml 3% NaCl. No significant difference in ICP and PRx was seen between groups at the HTS administration. ICP was lowered significantly in all children, with the effect lasting as long as 6 hours. The lowering of ICP was significantly greater and longer in children with a favorable outcome (p < 0.001); only this group showed significant improvement of autoregulatory capacity (p = 0.048). A newly established HTS response index clearly separated the outcome groups. CONCLUSIONS HTS significantly lowered ICP in all children after sTBI. This effect was significantly greater and longer-lasting in children with a favorable outcome. Moreover, HTS administration restored disturbed autoregulation only in the favorable outcome group. This highlights the role of a “rescuable” autoregulation regarding outcome, which might be a possible indicator of injury severity. The effect of HTS on autoregulation and other possible mechanisms should be further investigated.

23.4% Hypertonic Saline and Intracranial Pressure in Severe Traumatic Brain Injury Among Children

2019 ◽  
Vol 20 (5) ◽  
pp. 466-473 ◽  
Author(s):  
Andrew G. Wu ◽  
Uzma Samadani ◽  
Tina M. Slusher ◽  
Lei Zhang ◽  
Andrew W. Kiragu
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Intracranial Pressure ◽  
Hypertonic Saline ◽  
Severe Traumatic Brain Injury
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