Hostname: page-component-586b7cd67f-g8jcs Total loading time: 0 Render date: 2024-11-24T18:00:31.415Z Has data issue: false hasContentIssue false
  • English
  • Français

The role of hypertonic saline in neurotrauma

Published online by Cambridge University Press:  01 February 2008

H. White ,
D. Cook  and
B. Venkatesh
H. White
Affiliation:
QE II Hospital, Department of Anesthesiology, Brisbane, Australia
D. Cook
Affiliation:
University of Queensland, Princess Alexandra Hospital, Department of Intensive Care, Brisbane, Australia
B. Venkatesh*
Affiliation:
University of Queensland, Princess Alexandra Hospital, Department of Intensive Care, Brisbane, Australia
*
Correspondence to: Bala Venkatesh, Department of Intensive Care, Princess Alexandra Hospital, University of Queensland, Brisbane, 4102, Australia. E-mail: [email protected]; Tel: +61 7 3240 2111; Fax: +61 7 3636 1847
Get access

Summary

Animal and human studies suggest that hypertonic saline is a potential therapeutic agent to assist with the medical treatment of patients with traumatic brain injury. It may have a place as osmotherapy to decrease brain size, predominately of uninjured brain and has several potential advantages over mannitol. Hypertonic saline has clinically desirable physiological effects on cerebral blood flow, intracranial pressure and inflammatory responses in models of neurotrauma. Animal studies support its use, but definitive human trials using mortality end-points in brain trauma are lacking. Hypertonic saline may be considered a therapeutic adjunct to the medical management of traumatic brain injury, awaiting definitive evidence to support routine use.

Keywords

SALINE SOLUTION HYPERTONICINTRACRANIAL PRESSUREINTRACRANIAL HYPERTENSIONMANNITOL
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 25 , Issue S42 , February 2008 , pp. 104 - 109
Copyright
Copyright © European Society of Anaesthesiology 2008

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Shackford, SR, Zhuang, J, Schmoker, J. Intravenous fluid tonicity: effect on intracranial pressure, cerebral blood flow, and cerebral oxygen delivery in focal brain injury. J Neurosurg 1992; 76: 91–98.CrossRefGoogle ScholarPubMed
2.Wisner, DH, Schuster, L, Quinn, C. Hypertonic saline resuscitation of head injury: effects on cerebral water content. J Trauma 1990; 30: 75–78.CrossRefGoogle ScholarPubMed
3.The Brain Trauma Foundation. The American Association of Neurological Surgeons. The Joint Section on Neurotrauma and Critical Care. Initial management. J Neurotrauma 2000; 17: 463–469.Google Scholar
4.Maas, AI, Dearden, M, Teasdale, GM et al. . EBIC-guidelines for management of severe head injury in adults. European Brain Injury Consortium. Acta Neurochir (Wien) 1997; 139: 286–294.CrossRefGoogle ScholarPubMed
5.Fenstermacher, JD, Johnson, JA. Filtration and reflection coefficients of the rabbit blood–brain barrier. Am J Physiol 1966; 211: 341–346.CrossRefGoogle ScholarPubMed
6.Zornow, MH. Hypertonic saline as a safe and efficacious treatment of intracranial hypertension. J Neurosurg Anesthesiol 1996; 8: 175–177.CrossRefGoogle ScholarPubMed
7.Schmoker, JD, Shackford, SR, Wald, SL, Pietropaoli, JA. An analysis of the relationship between fluid and sodium administration and intracranial pressure after head injury. J Trauma 1992; 33: 476–481.CrossRefGoogle ScholarPubMed
8.Cross, JS, Gruber, DP, Gann, DS et al. . Hypertonic saline attenuates the hormonal response to injury. Ann Surg 1989; 209: 684–691.CrossRefGoogle ScholarPubMed
9.Hartl, R, Medary, MB, Ruge, M et al. . Hypertonic/hyperoncotic saline attenuates microcirculatory disturbances after traumatic brain injury. J Trauma 1997; 42: S41–S47.CrossRefGoogle ScholarPubMed
10.Hartl, R, Schurer, L, Schmid-Schonbein, EA. Antileukocyte interventions in experimental cerebral ischemia. J Cereb Blood Flow Metab 1997; 16: 1108–1119.CrossRefGoogle Scholar
11.Weed, LH, McKibben, PS. Experimental alteration of brain bulk. Am J Physiol 1919; 48: 531–558.CrossRefGoogle Scholar
12.Worthley, LI, Cooper, DJ, Jones, N. Treatment of resistant intracranial hypertension with hypertonic saline. Report of two cases. J Neurosurg 1988; 68: 478–481.CrossRefGoogle ScholarPubMed
13.Cooper, DJ, Myles, PS, McDermott, FT et al. . Prehospital hypertonic saline resuscitation of patients with hypotension and severe traumatic brain injury: a randomized controlled trial. JAMA 2004; 291: 1350–1357.CrossRefGoogle ScholarPubMed
14.Lighthall, JW, Dixon, CE, Anderson, TE. Experimental models of brain injury. J Neurotrauma 1989; 6: 83–97.CrossRefGoogle ScholarPubMed
15.Shackford, S. Effect of small-volume resuscitation on intracranial pressure and related cerebral variables. J Trauma 1997; 42: 48S–53S.CrossRefGoogle ScholarPubMed
16.Eilig, I, Rachinsky, M, Artru, AA et al. . The effect of treatment with albumin, hetastarch, or hypertonic saline on neurological status and brain edema in a rat model of closed head trauma combined with uncontrolled hemorrhage and concurrent resuscitation in rats. Anesth Analg 2001; 92: 669–675.CrossRefGoogle ScholarPubMed
17.Dubick, MA, Wade, CE. A review of the efficacy and safety of 7.5% NaCl/6% dextran 70 in experimental animals and in humans. J Trauma 1994; 36: 323–330.CrossRefGoogle ScholarPubMed
18.Gunnar, W, Jonasson, O, Merlotti, G et al. . Head injury and hemorrhagic shock: studies of the blood brain barrier and intracranial pressure after resuscitation with normal saline solution, 3% saline solution, and dextran-40. Surgery 1988; 103: 398–407.Google ScholarPubMed
19.Kramer, GC. Hypertonic resuscitation: physiologic mechanisms and recommendations for trauma care. J Trauma 2003; 54: S89–S99.Google ScholarPubMed
20.Ramming, S, Shackford, SR, Zhuang, J, Schmoker, JD. The relationship of fluid balance and sodium administration to cerebral edema formation and intracranial pressure in a porcine model of brain injury. J Trauma 1994; 37: 705–713.CrossRefGoogle Scholar
21.Bentsen, G, Breivik, H, Lundar, T, Stubhaug, A. Predictable reduction of intracranial hypertension with hypertonic saline hydroxyethyl starch: a prospective clinical trial in critically ill patients with subarachnoid haemorrhage. Acta Anaesthesiol Scand 2004; 48: 1089–1095.CrossRefGoogle ScholarPubMed
22.Murphy, N, Auzinger, G, Bernel, W, Wendon, J. The effect of hypertonic sodium chloride on intracranial pressure in patients with acute liver failure. Hepatology 2004; 39: 464–470.CrossRefGoogle ScholarPubMed
23.Schwarz, S, Georgiadis, D, Aschoff, A, Schwab, S. Effects of hypertonic (10%) saline in patients with raised intracranial pressure after stroke. Stroke 2002; 33: 136–140.CrossRefGoogle ScholarPubMed
24.Qureshi, AI, Suarez, JI, Castro, A, Bhardwaj, A. Use of hypertonic saline/acetate infusion in treatment of cerebral edema in patients with head trauma: experience at a single center. J Trauma 1999; 47: 659–665.CrossRefGoogle ScholarPubMed
25.Qureshi, AI, Suarez, JI, Bhardwaj, A. Malignant cerebral edema in patients with hypertensive intracerebral hemorrhage associated with hypertonic saline infusion: a rebound phenomenon? J Neurosurg Anesthesiol 1998; 10: 188–192.CrossRefGoogle ScholarPubMed
26.Simma, B, Burger, R, Falk, M et al. . A prospective, randomized, and controlled study of fluid management in children with severe head injury: lactated Ringer’s solution versus hypertonic saline. Crit Care Med 1998; 26: 1265–1270.CrossRefGoogle ScholarPubMed
27.Khanna, S, Davis, D, Peterson, B et al. . Use of hypertonic saline in the treatment of severe refractory posttraumatic intracranial hypertension in pediatric traumatic brain injury. Crit Care Med 2000; 28: 1144–1151.CrossRefGoogle ScholarPubMed
28.Vassar, MJ, Perry, CA, Gannaway, WL, Holcroft, JW. 7.5% sodium chloride/dextran for resuscitation of trauma patients undergoing helicopter transport. Arch Surg 1991; 126: 1065–1072.CrossRefGoogle ScholarPubMed
29.Vassar, MJ, Fischer, RP, O’Brien, PE et al. . A multicenter trial for resuscitation of injured patients with 7.5% sodium chloride. The effect of added dextran 70. The Multicenter Group for the Study of Hypertonic Saline in Trauma Patients. Arch Surg 1993; 128: 1003–1011, discussion 11–3.CrossRefGoogle Scholar
30.Wade, CE, Grady, JJ, Kramer, GC et al. . Individual patient cohort analysis of the efficacy of hypertonic saline/dextran in patients with traumatic brain injury and hypotension. J Trauma 1997; 42: S61–S65.CrossRefGoogle ScholarPubMed
31.Finfer, S, Bellomo, R, Boyce, N et al. . A comparison of albumin and saline for fluid resuscitation in the intensive care unit. N Engl J Med 2004; 350: 2247–2256.Google ScholarPubMed
32.Huang, PP, Stucky, FS, Dimick, AR et al. . Hypertonic sodium resuscitation is associated with renal failure and death. Ann Surg 1995; 221: 543–554.CrossRefGoogle ScholarPubMed
33.Adams, RD, Victor, M, Mancall, EL. Central pontine myelinolysis: a hitherto undescribed disease occurring in alcoholic and malnourished patients. AMA Arch Neurol Psychiatry 1959; 81: 154–172.CrossRefGoogle ScholarPubMed
34.Einhaus, SL, Croce, MA, Watridge, CB et al. . The use of hypertonic saline for the treatment of increased intracranial pressure. J Tenn Med Assoc 1996; 89: 81–82.Google ScholarPubMed
35.Hartl, R, Ghajar, J, Hochleuthner, H, Mauritz, W. Treatment of refractory intracranial hypertension in severe traumatic brain injury with repetitive hypertonic/hyperoncotic infusions. Zentralbl Chir 1997; 122: 181–185.Google ScholarPubMed
36.Schatzmann, C, Heissler, HE, Konig, K et al. . Treatment of elevated intracranial pressure by infusions of 10% saline in severely head injured patients. Acta Neurochir Suppl (Wien) 1998; 71: 31–33.Google ScholarPubMed
37.Horn, P, Munch, E, Vajkoczy, P et al. . Hypertonic saline solution for control of elevated intracranial pressure in patients with exhausted response to mannitol and barbiturates. Neurol Res 1999; 21: 758–764.CrossRefGoogle ScholarPubMed
38.Qureshi, AI, Suarez, JI, Bhardwaj, A et al. . Use of hypertonic (3%) saline/acetate infusion in the treatment of cerebral edema: Effect on intracranial pressure and lateral displacement of the brain. Crit Care Med 1998; 26: 440–446.CrossRefGoogle ScholarPubMed
39.Shackford, SR, Bourguignon, PR, Wald, SL et al. . Hypertonic saline resuscitation of patients with head injury: a prospective, randomized clinical trial. J Trauma 1998; 44: 50–58.CrossRefGoogle ScholarPubMed
40.Suarez, JI, Qureshi, AI, Bhardwaj, A et al. . Treatment of refractory intracranial hypertension with 23.4% saline. Crit Care Med 1998; 26: 1118–1122.CrossRefGoogle ScholarPubMed
41.Peterson, B, Khanna, S, Fisher, B, Marshall, L. Prolonged hypernatremia controls elevated intracranial pressure in head-injured pediatric patients. Crit Care Med 2000; 28: 1136–1143.CrossRefGoogle ScholarPubMed
42.Munar, F, Ferrer, AM, de Nadal, M et al. . Cerebral hemodynamic effects of 7.2% hypertonic saline in patients with head injury and raised intracranial pressure. J Neurotrauma 2000; 17: 41–51.CrossRefGoogle ScholarPubMed
43.Vialet, R, Albanese, J, Thomachot, L et al. . Isovolume hypertonic solutes (sodium chloride or mannitol) in the treatment of refractory posttraumatic intracranial hypertension: 2 mL/kg 7.5% saline is more effective than 2 mL/kg 20% mannitol. Crit Care Med 2003; 31: 1683–1687.CrossRefGoogle ScholarPubMed
44.White, H, Cook, D, Venkatesh, B. The use of hypertonic saline for treating intracranial hypertension after traumatic brain injury. Anesth Analg 2006; 102: 1836–1846.CrossRefGoogle ScholarPubMed