Current Purpose and Practice of Hypertonic Saline in Neurosurgery: A Review of the Literature

Thongrong, Cattleya; Kong, N.; Govindarajan, Barani; Allen, Duane; Mendel, Ehud; Bergese, Sergio D.

doi:10.1016/j.wneu.2013.02.027

Cited by 28 publications

(18 citation statements)

References 56 publications

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“…[2] Brain edema, which is defined as an increase in brain water content, is usually related to the brain injury and is caused by leakage owing to a damaged blood-brain barrier (BBB), dysfunction of capillary permeability, and an accumulation of osmolytes in the interstice, resulting in lysis, necrosis, and ischemia. [3,4] Brain edema is characterized by cell swelling, which alters the concentrations of cellular metabolites and subsequently affects brain functions. [5] During this period, the intracranial pressure is usually increased, which is followed by headache, coma, and life-threatening herniation.…”

Section: Introductionmentioning

confidence: 99%

Hypertonic saline protects brain endothelial cells against hypoxia correlated to the levels of estimated glomerular filtration rate and interleukin-1β

et al. 2017

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Objective:The aim of this study was to verify the protective effect of hypertonic saline (HS) on brain endothelial cells under hypoxic conditions and the relevant underlying mechanism.Methods:bEnd.3 cells were treated with oxygen-glucose deprivation (OGD)-induced injury. To measure HS performance, cell viability was determined using the 3-(4,5-dimethylthiazol-2-yl)-5-(3-carboxymethoxyphenyl)-2-(4-sulfophenyl)-2H-tetrazolium salt assay, and cell apoptosis was assessed by flow cytometry and Terminal deoxynucleotidyl transferase UTP nick-end labeling staining. RNA-seq was performed to assess the expression profiles and screen the candidate genes that participated in OGD-induced injury and the HS protective effect. Quantitative real-time polymerase chain reaction (qPCR) and western blot analysis were used to confirm the expression of candidate genes, and enzyme-linked immunosorbent assay was used to measure the level of interleukin (IL)-1β. Overexpression analyses were performed to confirm the functions of the differentially expressed genes.Results:HS with a concentration of 40 mmol/L NaCl had an obvious protective effect on bEnd.3 cells after OGD-induced injury, resulting in increased cell viability and a smaller percentage of apoptotic cells. According to the RNA-seq results, epidermal growth factor receptor (EGFR) was chosen as the differentially expressed gene target in this study. The qPCR and western blot analyses further confirmed that the levels of EGFR/phosphorylated epidermal growth factor receptor and IL-1β were enhanced after OGD-induced injury, but attenuated after treatment with 40 mmol/L of NaCl HS. Overexpressed EGFR reversed the protective effect of HS that caused low viability and high rates of apoptosis in cells.Conclusion:HS can protect endothelial cells against OGD-induced injury, but is affected by the expression of EGFR/p-EGFR and IL-1β.

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Section: Introductionmentioning

confidence: 99%

Hypertonic saline protects brain endothelial cells against hypoxia correlated to the levels of estimated glomerular filtration rate and interleukin-1β

et al. 2017

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“…Hyperosmolar agents create a gradient across the blood-brain barrier, causing a shift in fluid from the interstitial and intracellular space into the bloodstream. 68 This decreases the overall fluid volume within the brain and, through the principles of the Monro-Kellie hypothesis, results in a decrease in ICP.…”

Section: Hyperosmolar Agentsmentioning

confidence: 99%

“…Mannitol is a strong diuretic that can cause intravascular volume contraction and alter blood rheology. 68 Hypertonic saline has minimal diuretic effect and can increase blood pressure and serum sodium. In the setting of aSAH, parameters such as fluid balance, blood pressure, serum sodium, and serum osmolality must be managed carefully to prevent secondary injury and reduce the risk of vasospasm/DCI.…”

Section: Hyperosmolar Agentsmentioning

confidence: 99%

Management of raised intracranial pressure in aneurysmal subarachnoid hemorrhage: time for a consensus?

Alotaibi

Wang

Pasarikovski

et al. 2017

Neurosurgical Focus

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Elevated intracranial pressure (ICP) is a well-recognized phenomenon in aneurysmal subarachnoid hemorrhage (aSAH) that has been demonstrated to lead to poor outcomes. Despite significant advances in clinical research into aSAH, there are no consensus guidelines devoted specifically to the management of elevated ICP in the setting of aSAH. To treat high ICP in aSAH, most centers extrapolate their treatment algorithms from studies and published guidelines for traumatic brain injury. Herein, the authors review the current management strategies for treating raised ICP within the aSAH population, emphasize key differences from the traumatic brain injury population, and highlight potential directions for future research in this controversial topic.

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“…Asimismo, la literatura disponible sobre el uso de SSH está basada en ensayos clínicos no aleatorizados, por lo que la posología y la duración del tratamiento no pueden ser claramente definidos 40,41 .…”

Section: Solución Salina Hipertónica Al 3%unclassified

“…El SSH al 3% es un fluido capaz de aumentar de forma segura los niveles de natremia sin generar afectación neurológica, cardíaca o renal, que con frecuencia es administrado por un acceso venoso periférico con bajo riesgo de complicaciones 40,41 . Esta solución tiene la concentración mínima de sodio capaz de superar la máxima concentración osmolar de la orina, por lo que en caso de ser la única fuente de reposición, la natremia siempre aumentará, puesto que el fenómeno de desalinación será altamente improbable.…”

Section: Solución Salina Hipertónica Al 3%unclassified

Hiponatremias en el paciente neurocrítico: enfoque terapéutico basado en la evidencia actual

et al. 2015

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Current Purpose and Practice of Hypertonic Saline in Neurosurgery: A Review of the Literature

Cited by 28 publications

References 56 publications

Hypertonic saline protects brain endothelial cells against hypoxia correlated to the levels of estimated glomerular filtration rate and interleukin-1β

Hypertonic saline protects brain endothelial cells against hypoxia correlated to the levels of estimated glomerular filtration rate and interleukin-1β

Management of raised intracranial pressure in aneurysmal subarachnoid hemorrhage: time for a consensus?

Hiponatremias en el paciente neurocrítico: enfoque terapéutico basado en la evidencia actual

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