The Use of Hypertonic Saline for Treating Intracranial Hypertension After Traumatic Brain Injury

White, Hayden; Cook, David; Venkatesh, Balasubramanian

doi:10.1213/01.ane.0000217208.51017.56

Cited by 148 publications

(76 citation statements)

References 78 publications

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“…The literature from HICs (both adult and pediatric) has shown low rates of complications in a PICU setting [7,9,18,19]. Our study demonstrates that administration of 3% HTS through peripheral IV line is safe.…”

Section: Discussionmentioning

confidence: 52%

Hypertonic Saline: Safe therapy for Children with cute Brain Insult in Emergency Department of Low and Middle Income Country

Mohammad¹,

Banu²,

Brown³

et al. 2017

J Pediatr Care

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Hypertonic saline (HTS) has been used for some years to treat elevated intracranial pressure in children in high income countries. There is limited safety data from low and middle income countries. Objective:The primary objective of this study was to assess the immediate response and safety of intravenous administration of hypertonic saline in children with acute brain injury presenting to the pediatric emergency department (PED) of Aga Khan University Hospital (AKUH). The secondary outcomes were changes in outcome-predictive physiological parameters. Methods:A retrospective, chart review of children who received intravenous HTS in the pediatric emergency department of AKU between January 2013 and December 2013 to treat acute brain injury (ABI). We studied both changes in physiological parameters and adverse effects related to HTS therapy. Results:In the period studied, 216 children received intravenous bolus of 3% HTS as part of their initial management in the PED. The median age of the patients was 6.1 years (1 month to 16 years) and a median dose of 5 mL/kg with 98% of doses given via peripheral line between 30 minutes to one hour. Diagnosis included traumatic brain injury in 110 patients (50.9%) and non-traumatic injury 106 (49.1%) including CNS infection (43.4%), intracranial bleeding (7.5%), acute hepatic failure (10.4%), diabetic ketoacidosis with altered mental status (4.7%). Clinical indications included: depressed consciousness (75.5%), seizures (24%) and shock (0.5%). Significant improvement was observed in both heart rate (p value < 0.05) and GCS (p value=0.001) after 3% HTS therapy No adverse events related to the HTS or its route of administration were noted in any child. Conclusion:We found 3% HTS was safe in children with acute brain injury traumatic or non-traumatic brain injury.

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Section: Discussionmentioning

confidence: 52%

Hypertonic Saline: Safe therapy for Children with cute Brain Insult in Emergency Department of Low and Middle Income Country

Mohammad¹,

Banu²,

Brown³

et al. 2017

J Pediatr Care

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“…[12] In addition, the osmotic diuresis that accompanies mannitol administration may lead to hypotension, especially in hypovolemic patients, and may worsen secondary brain injury in TBI patients. [95] However, this review found that 60 (92%) identifi ed papers used mannitol to control ICP in pre-hospital settings. Twenty-eight (43%) papers even reported that they administered mannitol to all of their TBI patients (Table 7).…”

Section: Brain Herniationmentioning

confidence: 99%

Current pre-hospital traumatic brain injury management in China

Kou

Hou

Sun

et al. 2014

World Journal of Emergency Medicine

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BACKGROUND: Traumatic brain injury (TBI) is associated with most trauma-related deaths. Secondary brain injury is the leading cause of in-hospital deaths after traumatic brain injury. By early prevention and slowing of the initial pathophysiological mechanism of secondary brain injury, prehospital service can signifi cantly reduce case-fatality rates of TBI. In China, the incidence of TBI is increasing and the proportion of severe TBI is much higher than that in other countries. The objective of this paper is to review the pre-hospital management of TBI in China.DATA SOURCES: A literature search was conducted in January 2014 using the China National Knowledge Infrastructure (CNKI). Articles on the assessment and treatment of TBI in pre-hospital settings practiced by Chinese doctors were identified. The information on the assessment and treatment of hypoxemia, hypotension, and brain herniation was extracted from the identifi ed articles. RESULTS:Of the 471 articles identified, 65 met the selection criteria. The existing literature indicated that current practices of pre-hospital TBI management in China were sub-optimal and varied considerably across different regions. CONCLUSION:Since pre-hospital care is the weakest part of Chinese emergency care, appropriate training programs on pre-hospital TBI management are urgently needed in China.

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“…27,[33][34][35] Bolus dosing regimens vary within the literature. Some authors advocate the use of 2 mL/kg of 7.5% 27 for the control of elevated ICP, while others have used 250 mL boluses of 3% 36 or 30 mL of 23.4%. 37 To date, there are no direct comparison studies between these dosing regimens.…”

Section: Traumatic Brain Injurymentioning

confidence: 99%

Hypertonic Saline and Mannitol Therapy in Critical Care Neurology

Hinson

Stein

Sheth

2011

J Intensive Care Med

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Osmotic agents play a vital role in the reduction of elevated intracranial pressure and treatment of cerebral edema in Neurologic critical care. Both mannitol and hypertonic saline reduce cerebral edema in many clinical syndromes, yet there is controversy over agent selection, timing, and dosing regimens. Despite the lack of randomized, controlled trials, our knowledge base on the appropriate clinical use of osmotic agents continues to expand. This review will summarize the evidence for the use of mannitol and hypertonic saline in a variety of disease states causing cerebral edema, as well as outlining monitoring and safety considerations.

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The Use of Hypertonic Saline for Treating Intracranial Hypertension After Traumatic Brain Injury

Cited by 148 publications

References 78 publications

Hypertonic Saline: Safe therapy for Children with cute Brain Insult in Emergency Department of Low and Middle Income Country

Hypertonic Saline: Safe therapy for Children with cute Brain Insult in Emergency Department of Low and Middle Income Country

Current pre-hospital traumatic brain injury management in China

Hypertonic Saline and Mannitol Therapy in Critical Care Neurology

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