The use of Hypertonic Saline in the Treatment of Post-Traumatic Cerebral Edema: A Review

Abstract

Effective methods for treating cerebral edema have recently become a matter of both extensive research and significant debate within the neurosurgery and trauma surgery communities. The pathophysiologic progression and outcome of different forms of cerebral edema associated with traumatic brain injury have yet to be fully elucidated. There are heterogeneous factors influencing the onset and progress of post-traumatic cerebral edema, including the magnitude and type of head injury, age, co-morbid conditions of the patient, the critical window for therapeutic intervention and the presence of secondary insults including hypoxia, hypotension, hypo/hyperthermia, degree of raised intracranial pressure (ICP), and disruption of blood brain barrier (BBB) integrity. Although numerous studies have been designed to improve our understanding of the etiology of post-traumatic cerebral edema, therapeutic interventions have traditionally been focused on minimizing secondary insults especially raised ICP and improving cerebral perfusion pressure. More recently, fluid resuscitation strategies using hyperosmolar agents such as pentastarch and hypertonic saline (HS) have achieved some success. HS treatment is of particular interest due to its apparent advantageous action over other types of hyper-osmotic solutions in both clinical and laboratory studies. In this review, we provide a summary of recent literature concerning the pathogenesis and mechanisms involved in the various types of cerebral edema, and the possible mechanisms of action of HS for the treatment cerebral edema.

Does Serum Osmolarity Change as a Result of the Reflex Neuroprotective Mechanism of Cerebral Osmo-Regulation after Minor Head Trauma?

“…It has been reported that, in experimental rat models of moderate TBI, serum magnesium level decreases and calcium/ magnesium level increases 22) . The use of hypertonic saline in the treatment of post-traumatic cerebral edema has been reported 8) .…”

Role of permissive hypotension, hypertonic resuscitation and the global increased permeability syndrome in patients with severe hemorrhage: adjuncts to damage control resuscitation to prevent intra-abdominal hypertension

“…Furthermore, they also noted umbrella effect benefits including a reduced incidence of ARDS, pneumonia, sepsis and arrhythmias. The presumed benefits of HTS including preserved microvascular flow, decreased tissue oedema, and attenuated inflammatory response, may be particularly useful in brain-injured patients where cerebral oedema and intracranial hypertension lead to deleterious outcomes when aggressive fluid resuscitation is needed to maintain global haemodynamics [61]. More recently, several studies have compared HTS to mannitol for the control of intracranial hypertension, noting improved control with HTS [62].…”

Effect of Hypotensive Resuscitation with a Novel Combination of Fluids in a Rabbit Model of Uncontrolled Hemorrhagic Shock

“…In addition, studies [12], [13] demonstrated that HSS might have beneficial effects by modulating the excessive immune-inflammatory response on hemorrhagic shock. Particularly, HSS was said to play an important role in the treatment of traumatic brain injury via raising intracranial pressure and cerebral oxygenation [14], [15]. In recent study, authors [16] found that HSS also improved hemodynamic function by stimulating cardiac sympathetic nerve activity after hemorrhage shock.…”