Hypertonic saline for treating raised intracranial pressure: literature review with meta-analysis

Mortazavi, Martin M.; Romeo, Andrew; Deep, Aman; Griessenauer, Christoph J.; Shoja, Mohammadali Mohajel; Tubbs, R. Shane; Fisher, Winfield S.

doi:10.3171/2011.7.jns102142

Cited by 168 publications

(110 citation statements)

References 43 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…One review, as with ours, concluded that hypertonic saline solution has no effect on mortality 21 ; another study reporting on mortality suggested a decreased mortality with the use of hypertonic saline. 16 With regards to the five systematic reviews evaluating intracranial pressure management, they identified a reduction in intracranial pressure [16][17][18][19][20] associated with hypertonic saline solution, in contrast with our results. These discrepancies may be due to several factors.…”

Section: Discussioncontrasting

confidence: 74%

“…[16][17][18][19][20][21] All reviews posed a different clinical question and used different inclusion criteria. One review, as with ours, concluded that hypertonic saline solution has no effect on mortality 21 ; another study reporting on mortality suggested a decreased mortality with the use of hypertonic saline.…”

Section: Discussionmentioning

confidence: 99%

“…Two reviews 18,19 included all study designs (retrospective, observational, randomized controlled trials). Four reviews [17][18][19][20] included several neurosurgical pathologies beyond severe traumatic brain injury (e.g., tumor, stroke). By only including randomized controlled trials of patients with severe traumatic brain injury, we achieved less clinical heterogeneity.…”

Section: Discussionmentioning

confidence: 99%

“…[13][14][15] Six systematic reviews aiming to evaluate the effect of hypertonic saline in neurocritically ill patients have been published showing inconsistent results. [16][17][18][19][20][21] However, these systematic reviews have important methodological flaws, notably the inclusion of studies with different designs and search strategies with low sensitivity. Furthermore, these reviews did not include the most recent publications.…”

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Hypertonic saline in severe traumatic brain injury: a systematic review and meta-analysis of randomized controlled trials

Berger-Pelleiter

Émond

Lauzier

et al. 2016

CJEM

View full text Add to dashboard Cite

Objectives: Hypertonic saline solutions are increasingly used to treat increased intracranial pressure following severe traumatic brain injury. However, whether hypertonic saline provides superior management of intracranial pressure and improves outcome is unclear. We thus conducted a systematic review to evaluate the effect of hypertonic saline in patients with severe traumatic brain injury. Methods: Two researchers independently selected randomized controlled trials studying hypertonic saline in severe traumatic brain injury and collected data using a standardized abstraction form. No language restriction was applied. We searched MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Scopus, Web of Science, and BIOSIS databases. We searched grey literature via OpenGrey and National Technical Information Service databases. We searched the references of included studies and relevant reviews for additional studies.Results: Eleven studies (1,820 patients) were included. Hypertonic saline did not decrease mortality (risk ratio 0.96, 95% confidence interval [CI] 0.83 to 1.11, I 2 = 0%) or improve intracranial pressure control (weighted mean difference −1.25 mm Hg, 95% CI −4.18 to 1.68, I 2 = 78%) as compared to any other solutions. Only one study reported monitoring for adverse events with hypertonic saline, finding no significant differences between comparison groups. Conclusions: We observed no mortality benefit or effect on the control of intracranial pressure with the use of hypertonic saline when compared to other solutions. Based on the current level of evidence pertaining to mortality or control of intracranial pressure, hypertonic saline could thus not be recommended as a first-line agent for managing patients with severe traumatic brain injury. RÉSUMÉObjectifs: Les solutés salés hypertoniques sont de plus en plus utilisés dans le traitement de l'élévation de la pression intracrânienne par suite d'une lésion cérébrale traumatique grave. Toutefois, on ne sait pas avec certitude si les solutés salés hypertoniques sont plus efficaces que d'autres traitements dans l'abaissement de la pression intracrânienne et s'ils donnent de meilleurs résultats. Les auteurs ont donc entrepris une revue systématique de la documentation afin d'évaluer l'effet des solutés salés hypertoniques chez les patients ayant subi une lésion cérébrale traumatique grave. Méthode: Deux chercheurs ont sélectionné chacun de leur côté des essais comparatifs à répartition aléatoire portant sur l'utilisation du soluté salé hypertonique dans le traitement des lésions cérébrales traumatiques graves, et ont recueilli des données sur un formulaire normalisé de résumé analytique. Aucune restriction de langue n'a été appliquée. Des recherches ont été effectuées dans les bases de données Medline, Embase, Cochrane Central Register of Controlled Trials, Scopus, Web of Science et Biosis. Les auteurs ont également consulté la documentation parallèle en passant par les bases de données OpenGrey et National Technical Information Service. Enfi...

show abstract

Section: Discussioncontrasting

confidence: 74%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Hypertonic saline in severe traumatic brain injury: a systematic review and meta-analysis of randomized controlled trials

Berger-Pelleiter

Émond

Lauzier

et al. 2016

CJEM

View full text Add to dashboard Cite

show abstract

“…Hyperventilation is now reserved as one of the latter options for managing refractory intracranial pressure after it was discovered that clinical outcomes were worse due to loss of the vasoconstrictive effect and rebound ICP [6]. Regarding hyperosmotics, a recent review demonstrated that hypertonic saline was superior to mannitol in decreasing intracranial pressure; however, it was inconclusive whether hypertonic saline (HTS) surpasses mannitol in clinical outcomes [7]. The physiologic advantage of HTS is not only its intravascular oncotic effect, but its ability to reduce blood viscosity, increase RBC rheology, and induce endothelial cell shrinkage, which all lead to improved circulation, cerebral blood flow, and decreased intracranial pressure without the diuretic effect of mannitol that can further exacerbate secondary injury mechanisms.…”

mentioning

confidence: 99%

State of the Art in Cerebral Trauma: A Neurosurgeon’s Perspective

Hsu

Keen

2011

Transl. Stroke Res.

View full text Add to dashboard Cite

CommentaryNeurosurgery has always played an integral role in the management of cerebral trauma but, historically, treatments were limited and mortality and morbidity high. While cerebral trauma remains a leading cause of death worldwide, advancements in basic science injury models, pharmacology, and prevention strategies over the past several decades have resulted in a better understanding of injury mechanisms and have lead to improved outcomes in certain groups. The elucidation of the pathophysiology of secondary brain injury has lead to more targeted therapies; and the establishment of evidence-based guidelines has systematized the management of cerebral trauma, spawning the growth of neurocritical care, multimodal neuromonitoring, and the resurgence of surgical management.Cerebral trauma consists of a heterogeneous group of primary injuries with different causes, presentations, severity, and outcomes, but the final common pathway that leads to the most deleterious effects is that of secondary injury, which involves complex biomechanical and biochemical-triggered cascades that lead to cerebral ischemia, metabolic derangements, inflammation, edema, and cell death. Once cerebral blood flow, and therefore oxygenation, is diminished, neurons depolarize and release excitatory neurotransmitters, such as glutamate, that act at NMDA and AMPA receptors to permit massive influxes of sodium and calcium. The influx of calcium, in particular, activates multiple self-digesting mechanisms that lead to membrane damage, DNA degradation, and ultimately cell death [1]. These processes will often propagate until diffuse ischemia, inflammation, and edema lead to brain herniation and death, unless there is prompt intervention.The goal of neurocritical care is to anticipate the evolution of secondary injury and intervene early. Traditionally, this has been accomplished by measuring intracranial pressure (ICP) with external ventricular drains and parenchymal monitors to derive cerebral perfusion pressure (CPP) by subtracting ICP from mean arterial pressure. The goal has been to keep CPP above an acceptable threshold to ensure adequate cerebral perfusion and oxygenation. While consensus exists for treating ICP greater than 20 mmHg, CPP management has been less straightforward. Some studies have demonstrated improved outcomes with CPP >70 mmHg, whereas several others have not and revealed high rates of pulmonary complications [2]. Currently, the recommended threshold below which CPP should not fall is 50 mmHg, but artificially driving CPP higher than 70 mmHg has fallen out of favor [3]. The difficulty with an ICP and CPP management strategy is that some individuals may benefit from higher or lower CPP values depending upon the nature of their injury. Another complicating factor is that focal injury causing regional metabolic derangements may not be detected by more globally oriented monitoring techniques, such as intracranial pressure monitoring, whereas focal monitoring may not detect the presence of larger areas of injury if the devi...

show abstract

Hypertonic saline versus other intracranial pressure-lowering agents for people with acute traumatic brain injury

Chen

Song

Dennis

2019

Cochrane Database of Systematic Reviews

View full text Add to dashboard Cite

show abstract

Hypertonic saline for treating raised intracranial pressure: literature review with meta-analysis

Cited by 168 publications

References 43 publications

Hypertonic saline in severe traumatic brain injury: a systematic review and meta-analysis of randomized controlled trials

Hypertonic saline in severe traumatic brain injury: a systematic review and meta-analysis of randomized controlled trials

State of the Art in Cerebral Trauma: A Neurosurgeon’s Perspective

Hypertonic saline versus other intracranial pressure-lowering agents for people with acute traumatic brain injury

Contact Info

Product

Resources

About