Role of continuous hypertonic saline in acute ischemic infarcts: a systematic literature review

Chugh, Arunit J S; Maynard, Marquis; Sunshine, Kerrin; Shammassian, Berje; Sauer, Adam; Odetoyinbo, Kolade; Hoffer, S. Alan

doi:10.18700/jnc.210007

Cited by 3 publications

(2 citation statements)

References 19 publications

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“…42 A systematic review by Chugh et al on the effects of continuous HTS therapy in patients with acute ischemic infarcts, concluded that although HTS administration demonstrated improvement in the ICP, there was no significant improvement in the mortality and neurological/functional outcomes. 43…”

Section: Clinical Uses Of Hypertonic Salinementioning

confidence: 99%

Use of Hypertonic Saline in Neuroanesthesia and Neurocritical Care Practice: A Narrative Review

Barik

Thappa

Jangra

et al. 2023

J Neuroanaesth Crit Care

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Hypertonic saline (HTS) is a group of fluids containing sodium and chloride in a higher concentration as compared to physiological saline. The authors have conducted this review to evaluate the use of HTS in neuroanesthesia and neurocritical care. The articles for this narrative review on HTS were searched on databases like PubMed Central, EMBASE, and Google Scholar using the Medical Subject Headings keywords “Hypertonic Saline,” “Neuroanesthesia,” and “Neurocritical Care.” The review focuses on the mechanisms of HTS and its in routine clinical practice. The results of various comparative studies between HTS and mannitol and guidelines regarding the use of HTS have also been reviewed. HTS can be used to treat hyponatremia, reduce intracranial pressure, provide intraoperative relaxed brain, and aid in resuscitation during cardiogenic, neurogenic, and septic shock. Its side effects include renal toxicity in the case of hypernatremia, rebound intracranial hypertension, volume overload, dyselectrolytemia, phlebitis, local tissue damage, and osmotic demyelination syndrome in the case of rapid correction of serum sodium concentration.

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Section: Clinical Uses Of Hypertonic Salinementioning

confidence: 99%

Use of Hypertonic Saline in Neuroanesthesia and Neurocritical Care Practice: A Narrative Review

Barik

Thappa

Jangra

et al. 2023

J Neuroanaesth Crit Care

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“…렵고, 그에 따라 뇌압조절에 실패하게 된다 [5][6][7][8]. 따라서 이 논문에서는 만니톨과 고장성 식염수를 사용하면서 발생할 수 있는 대표적인 부작용을 이해하고, 부작용을 최소화하면서 고삼투압 치료를 할 수 있는 방법에 대해 알아보고자 한다.…”

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Management of adverse effects in hyperosmolar therapy of brain edema

Park¹,

Ko²

2023

J Korean Med Assoc

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Background: Mannitol and hypertonic saline are the most frequently used hyperosmolar agents to treat cerebral edema resulting from acute brain injury. However, there are several issues with using hyperosmolar therapies. Here, we focus on the potential adverse effects of hyperosmolar therapies and practical tips to overcome these issues in the neurointensive care unit.Current Concepts: Among the hyperosmolar agents used, mannitol may decrease intravascular volume and pose a potential risk of acute kidney injury for patients. Complications associated with using hypertonic saline include the risk of central pontine myelinolysis, coagulopathy, electrolyte imbalances, metabolic acidosis, and pulmonary edema. In addition, prolonged use of hypertonic saline increases the risk of hyperchloremic metabolic acidosis, which may be overcome with the concomitant use of sodium acetate.Discussion and Conclusion: Several laboratory variables were monitored in the neurointensive care unit to limit and possibly detect early complications related to hyperosmolar therapies. When using hyperosmolar agents, including mannitol and hypertonic saline, for therapeutic purposes in patients with cerebral edema, determining whether to use peripheral or central lines and determining the appropriate rate and infusion dose can minimize their adverse effects. Clinicians need to be aware of the potential adverse events of administering hyperosmolar agents.

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No Benefit of 3% Hypertonic Saline Following Experimental Intracerebral Hemorrhage

Kung,

Kalisvaart,

Suerte

et al. 2024

Neurotox Res

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Intracerebral hemorrhage (ICH) is a stroke subtype with a high mortality rate (~ 40%). After ICH, the mass effect of the hematoma and edema contribute to raised intracranial pressure (ICP) and poor outcome. Endogenous compensatory mechanisms that blunt ICP elevations include redirection of venous blood and cerebrospinal fluid, along with brain tissue compliance (e.g., decreased cell volume, increased cell density); however, these limited reserves can be exhausted after severe stroke, resulting in decompensated ICP that requires careful clinical management. Management strategies can include administration of hypertonic saline (HTS), an osmotic agent that putatively attenuates edema, and thereby ICP elevations. Evidence regarding the efficacy of HTS treatment following ICH remains limited. In this study, adult male rats were given a collagenase-induced striatal ICH and a bolus of either 3% HTS or 0.9% saline vehicle at 2- and 14-hours post-stroke onset. Neurological deficits, edema, ipsilateral cell volume and density (in areas S1 and CA1), and contralateral CA1 ultrastructural morphology were assessed 24 h post-ICH. Animals had large bleeds (median 108.2 µL), extensive edema (median 83.9% brain water content in ipsilateral striatum), and evident behavioural deficits (median 5.4 neurological deficit scale score). However, HTS did not affect edema (p ≥ 0.4797), behaviour ( p = 0.6479), cell volume (p ≥ 0.1079), or cell density (p ≥ 0.0983). Qualitative ultrastructural assessment of contralateral area CA1 suggested that HTS administration was associated with paradoxical cellular swelling in ICH animals. Overall, there was no benefit with administering 3% HTS after ICH. Supplementary Information The online version contains supplementary material available at 10.1007/s12640-024-00722-2.

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Role of continuous hypertonic saline in acute ischemic infarcts: a systematic literature review

Cited by 3 publications

References 19 publications

Use of Hypertonic Saline in Neuroanesthesia and Neurocritical Care Practice: A Narrative Review

Use of Hypertonic Saline in Neuroanesthesia and Neurocritical Care Practice: A Narrative Review

Management of adverse effects in hyperosmolar therapy of brain edema

No Benefit of 3% Hypertonic Saline Following Experimental Intracerebral Hemorrhage

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