Individual Patient Cohort Analysis of the Efficacy of Hypertonic Saline/Dextran in Patients with Traumatic Brain Injury and Hypotension

Abstract

Patients who have traumatic brain injuries in the presence of hypotension and receive HSD are about twice as likely to survive as those who receive standard of care.

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

“…[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.…”

“…[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. 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.…”

“…[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.…”

Care of the Stroke Patient: Routine Management to Lifesaving Treatment Options

“…They found improved systolic blood pressure on arrival to the emergency room. In 1997, Wade et al [58] performed a cohort analysis of patient data from previous prospective, randomized doubleblinded trials that evaluated the use of hypertonic saline/ dextran (HSD) solution in patients who had a traumatic brain injury (TBI). They found patients with TBI who had received the hypertonic saline/dextran solution were twice as likely to survive as those who received standard care.…”

Hypertonic Saline Solution Increases Cerebral Perfusion Pressure During Clinical Orthotopic Liver Transplantation for Fulminant Hepatic Failure: Preliminary Results

“…17 In clinical trials, the beneficial effects of HSS during hemorrhagic shock in the presence of intracranial hypertension associated with systemic hypotension have been noted. 18,19 Increasing evidence suggests important advantages in HSS resuscitation, namely, reduction in postresuscitation complications such as renal failure, coagulopathies, and acute respiratory distress syndrome, possibly by modulation of the systemic inflammatory response. [20][21][22] The findings that HSS induces favorable effects on both systemic and cerebral hemodynamics in laboratory and clinical settings of IH suggest a potential use of this solution during OLT for FHF.…”