Effects of Hypertonic (7%) Saline on Brain Injury in Experimental Escherichia coli Meningitis

Abstract

We sought to know whether hypertonic (7%) saline (HTS) attenuates brain injury by improving cerebral perfusion pressure (CPP) and down-modulating acute inflammatory responses in experimental bacterial meningitis in the newborn piglet. Twenty-five newborn piglets were assorted into three groups: 6 in the control group (C), 10 in the meningitis group (M), and 9 in the meningitis with HTS infusion group (H). Meningitis was induced by intracisternal injection of 108 colony forming units of Escherichia coli in 100 µL of saline. 10 mL/kg of HTS was given intravenously as a bolus 6 hr after induction of meningitis, thereafter the infusion rate was adjusted to maintain the serum sodium level between 150 and 160 mEq/L. HTS significantly attenuated meningitis-induced brain cell membrane disintegration and dysfunction, as indicated by increased lipid peroxidation products and decreased Na+, K+-ATPase activity in the cerebral cortex in M. HTS significantly attenuated acute inflammatory markers such as increased intracranial pressure, elevated lactate level and pleocytosis in the cerebrospinal fluid observed in M. Reduced CPP observed in M was also significantly improved with HTS infusion. These findings implicate some attenuation of the meningitis-induced alterations in cerebral cortical cell membrane structure and function with HTS, possibly by improving CPP and attenuating acute inflammatory responses.

Superior effect of hypertonic saline over mannitol to attenuate cerebral edema in a rabbit bacterial meningitis model*

“…HTS has an anti-inflammatory effect (31). Choi et al (12) reported that 7% HTS therapy alone significantly reduced acute inflammatory responses in an experimental BM piglet model. Results in this work also showed that adjuvant 3% HTS therapy significantly reduced the number of leukocytes and protein content in CSF (Fig.…”

“…Recently, hypertonic saline (HTS) has become a promising alternative to glycerol and MN for the treatment of cerebral edema and reducing elevated ICP. In a piglet BM model, 7% HTS alone had been shown to attenuate acute inflammatory responses and improve CPP (12). However, until now, there has been no report as if there was any advantage of using HTS over glycerol or MN for the adjuvant treatment of BM.…”

Late Decrease in Cerebral Blood Flow in Bacterial Meningitis: More than a Simple Normalization of Acute Inflammatory Vessel Wall Architecture?

“…[203]. Additionally, in a piglet model of bacterial meningitis, 7% of HTS was shown to considerably downregulate acute inflammatory responses leading to a significant reduction in ICP and improvement in CPP, thereby decreasing the likelihood of cerebral ischemia and resultant brain injury [204]. Separately, a comparative study between 3% HTS and 20% mannitol (MN) in severe acute bacterial meningitis, HTS was reported to more consistently and efficiently decrease ICP and improve CPP, thus better attenuating brain edema development to subsequently lower cerebral vessel resistance and improve CBF and prevent cerebral ischemic damage [205].…”

Osmotic therapies added to antibiotics for acute bacterial meningitis

“…The high mortality is predominately seen in Streptococcus pneumoniae ( S pneumoniae ) infections; meningitis caused by Neisseria meningitidis ( N meningitidis ) carries a lower mortality. In children, a wider range of pathogens are noted and the case fatality rate is lower (Harnden 2006; Molyneux 2006; Pelkonen 2009; Peltola 2009; Roine 2009). Nevertheless, some survivors develop neurological problems that may be permanent.…”