Faculty Opinions recommendation of Assessing the impact of 3% hypertonic saline hyperosmolar therapy on intubated children with isolated traumatic brain injury by cerebral oximetry in a pediatric emergency setting.

2021 ◽  
Author(s):  
Saskia de Wildt ◽  
Gerald Jaspers
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Hypertonic Saline ◽  
Pediatric Emergency ◽  
Cerebral Oximetry ◽  
Emergency Setting ◽  
Hyperosmolar Therapy ◽  
The Impact

scholarly journals Sugar or salt (“SOS”): A protocol for a UK multicentre randomised trial of mannitol and hypertonic saline in severe traumatic brain injury and intracranial hypertension

2020 ◽  
pp. 175114372090169
Author(s):  
MJ Rowland ◽  
T Veenith ◽  
C Scomparin ◽  
MH Wilson ◽  
PJ Hutchinson ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Cost Effectiveness ◽  
Brain Injury ◽  
Intracranial Pressure ◽  
Hypertonic Saline ◽  
Severe Traumatic Brain Injury ◽  
Randomised Trial ◽  
Pragmatic Trial ◽  
Open Label ◽  
The Impact

Hyperosmolar solutions are widely used to treat raised intracranial pressure following severe traumatic brain injury. Although mannitol has historically been the most frequently administered, hypertonic saline solutions are increasingly being used. However, definitive evidence regarding their comparative effectiveness is lacking. The Sugar or Salt Trial is a UK randomised, allocation concealed open label multicentre pragmatic trial designed to determine the clinical and cost-effectiveness of hypertonic saline compared with mannitol in the management of patients with severe traumatic brain injury. Patients requiring intensive care unit admission and intracranial pressure monitoring post-traumatic brain injury will be allocated at random to receive equi-osmolar boluses of either mannitol or hypertonic saline following failure of routine first-line measures to control intracranial pressure. The primary outcome for the study will be the Extended Glasgow Outcome Scale assessed at six months after randomisation. Results will inform current clinical practice in the routine use of hyperosmolar therapy as well as assess the impact of potential side effects. Pre-planned longer term clinical and cost effectiveness analyses will further inform the use of these treatments.

scholarly journals Hyperosmolar Therapy for Severe Traumatic Brain Injury in Pediatrics: A Review of the Literature

2019 ◽  
Vol 24 (6) ◽  
pp. 465-472 ◽  
Author(s):  
Norman E. Fenn ◽  
Caroline M. Sierra
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Hypertonic Saline ◽  
Severe Traumatic Brain Injury ◽  
Serum Sodium ◽  
Cochrane Library ◽  
Coronary Perfusion ◽  
Hyperosmolar Therapy ◽  
Serum Osmolarity ◽  
Strong Conclusion

Traumatic brain injury remains a leading cause of morbidity and mortality in children. The use of hyperosmolar therapy to offset increased intracranial pressure (ICP) is described in pediatric guidelines, yet some controversy remains regarding which option to select. A search was conducted using the PubMed, MEDLINE, Cumulative Index of Nursing and Allied Health, Academic Search Premier, PsycInfo, and Cochrane Library databases. Studies were included if they described the hyperosmolar therapy use, involved severe traumatic brain injury (TBI), and patient age was 0 to 18 years. A total of 331 studies published between 1987 and 2017 were retrieved; of these, 9 met the inclusion criteria. Included studies were evaluated for the type and concentration of hyperosmolar therapy, associated mortality outcomes, ICP and coronary perfusion pressure (CPP) measurements, concurrent medications, and reported serum sodium and serum osmolarity or osmolality values. Hypertonic saline was the most commonly reported hyperosmolar therapy. Mannitol was less studied, but collectively demonstrated a higher incidence of mortality than hypertonic saline. There were several studies that did not report monitoring outcomes associated with serum sodium and/or serum osmolarity, despite the use of hyperosmolar therapies. Inconsistencies were noted between the studies in the overall study design as well as reported monitoring parameters and length of stay. Hypertonic saline appears to be safe and efficacious at several concentrations for treatment of increased ICP associated with severe TBI in pediatric patients. The limited available data regarding the use of mannitol do not allow a strong conclusion to be made regarding its use.

scholarly journals TERAPI HIPEROSMOLAR SEBAGAI TATA LAKSANA EDEMA SEREBRI PASCACEDERA KEPALA: LAPORAN KASUS BERBASIS BUKTI

2018 ◽  
Vol 36 (1) ◽  
Author(s):  
Ramdinal Aviesena Zairinal ◽  
Irma Savitri Madjid ◽  
Yetty Ramli ◽  
Diatri Nari Lastri ◽  
Adre Mayza
Keyword(s):  
Systematic Review ◽  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Intracranial Pressure ◽  
Hypertonic Saline ◽  
Cerebral Edema ◽  
Google Scholar ◽  
Literature Searching ◽  
Hyperosmolar Therapy ◽  
Cochrane Database

    HYPEROSMOLAR THERAPY FOR CEREBRAL EDEMA POST TRAUMATIC BRAIN INJURY: AN EVIDENCE-BASED CASE REPORTABSTRACTMannitol is an agent widely used to treat hyperosmolarity in cases of increased intracranial pressure after acute traumatic brain injury (TBI). Hypertonic saline is an alternative agent in such cases but is still not well-recognized in daily practice. Thus, a literature searching was conducted to see whether mannitol is more effective and safer than hypertonic saline in reducing intracranial pressure in patients with cerebral edema post TBI. The results of literature searching using PubMed, Google Scholar, and Cochrane Database of Systematic Review showed that there is no clear evidence suggesting mannitol is better than hypertonic saline, and vice versa. Therefore, hypertonic saline should be considered as an alternative treatment for hyperosmolarity besides mannitol.Keywords: Cerebral edema, hyperosmolar therapy, hypertonic saline, mannitol, traumatic brain injuryABSTRAKManitol sebagai agen terapi hiperosmolar untuk menurunkan tekanan intrakranial (TIK) pascacedera kepala telah digunakan secara luas. Sementara pilihan lainnya, yaitu larutan salin hipertonik, masih jarang diaplikasikan pada praktik sehari-hari. Oleh karena itu, dilakukan pencarian literatur untuk menilai efektivitas dan keamanan manitol dibandingkan larutan  salin  hipertonik  dalam  menurunkan  tekanan  intrakranial  berdasarkan  kasus  pasien  yang  mengalami  edema serebri pascacedera kepala. Hasil pencarian di PubMed, Google Scholar, dan Cochrane Database of Systematic Review menunjukkan belum ada bukti ilmiah yang secara tegas menyimpulkan manitol lebih efektif dan aman daripada larutan salin hipertonik maupun sebaliknya. Oleh karena itu, larutan salin hipertonik dapat dijadikan alternatif terapi hiperosmolar selain manitol.Kata kunci: Cedera kepala, edema serebri, manitol, salin hipertonik, terapi hiperosmolar

scholarly journals Sugar or Salt (“SOS”): a protocol for a UK multicentre randomised trial of mannitol and hypertonic saline in severe traumatic brain injury and intracranial hypertension

2019 ◽  
Author(s):  
MJ Rowland ◽  
T Veenith ◽  
C Scomparin ◽  
MH Wilson ◽  
PJ Hutchinson ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Cost Effectiveness ◽  
Brain Injury ◽  
Intracranial Pressure ◽  
Hypertonic Saline ◽  
Severe Traumatic Brain Injury ◽  
Randomised Trial ◽  
Pragmatic Trial ◽  
Open Label ◽  
The Impact

AbstractHyperosmolar solutions are widely used to treat raised intracranial pressure (ICP) following severe traumatic brain injury (TBI). Although mannitol has historically been the most frequently administered, hypertonic saline (HTS) solutions are increasingly being used. However, definitive evidence regarding their comparative effectiveness is lacking. The Sugar or Salt (SOS) Trial is a UK randomised, allocation concealed open label multicentre pragmatic trial designed to determine the clinical and cost-effectiveness of hypertonic saline (HTS) compared with mannitol in the management of patients with severe TBI. Patients requiring intensive care unit admission and intracranial pressure (ICP) monitoring post-TBI will be allocated at random to receive equi-osmolar boluses of either mannitol or HTS following failure of routine first line measures to control ICP. The primary outcome for the study will be the Extended Glasgow Outcome Scale (GOS-E) assessed at 6 months after randomisation. Results will inform current clinical practice in the routine use of hyperosmolar therapy as well as assess the impact of potential side effects. Pre-planned longer term clinical and cost effectiveness analyses will further inform the use of these treatments.

Hypertonic saline in traumatic brain injury: Current status

2004 ◽  
Vol 1 (2) ◽  
pp. 15-20 ◽  
Author(s):  
Kavita Sandhu ◽  
TVSP Murthy ◽  
Brig T Prabhakar
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Hypertonic Saline ◽  
Current Status
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