Hypertonic Saline Resuscitation of Patients with Head Injury

Shackford, Steven R.; Bourguignon, Paul; Wald, Steven L.; Rogers, Frederick B.; Osler, Turner M.; Clark, David E.

doi:10.1097/00005373-199801000-00004

Cited by 191 publications

(95 citation statements)

References 36 publications

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“…[27][28][29][30][31][32][33][34][35][36][37] All studies were published in English. Of the 11 studies, only 3 included more than 100 patients 27,31,32 ( Table 1).…”

Section: Study Characteristicsmentioning

confidence: 99%

“…30 In one study, three patients (0.01% of our total population) with stroke were also included, which represented less than 15% of that study's patient population. 34 Three comparators were identified: hyperosmolar solution (mannitol or sodium bicarbonate), 28,[33][34][35]37 iso-osmolar solution (normal saline or ringer's lactate), 27,31,32 and hypo-osmolar solution 36 (see Table 1). …”

Section: Study Characteristicsmentioning

confidence: 99%

“…27,[31][32][33]35,36 In six studies (63%), the research staff, patients, and medical staff were not blinded to the intervention studied. 27,28,30,33,34,37 The information regarding blinding was missing in three studies (27%).…”

Section: Risk Of Bias Assessmentmentioning

confidence: 99%

“…27,28,30,33,34,37 The information regarding blinding was missing in three studies (27%). 29,35,36 In one study (9%), an additional source of bias was identified 36 : the study treatment and control groups were not comparable because the baseline Glasgow Coma Scale score was lower in the hypertonic saline solution group.…”

Section: Risk Of Bias Assessmentmentioning

confidence: 99%

“…30,31,[33][34][35][36] We pooled data on the best (lowest) mean intracranial pressure measurement from each study in order to capture the intervention with the greatest effect (see Table 1). We did not observe a significant better control of intracranial pressure with the use of hypertonic saline as compared with other solutions (k = 6, n = 532, WMD −0.39, 95% CI −3.78 to 2.99, I 2 = 79%) (Figure 3).…”

Section: Intracranial Pressurementioning

confidence: 99%

See 4 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

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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...

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“…[27][28][29][30][31][32][33][34][35][36][37] All studies were published in English. Of the 11 studies, only 3 included more than 100 patients 27,31,32 ( Table 1).…”

Section: Study Characteristicsmentioning

confidence: 99%