Hypertonic Saline Fluid Therapy Following Brain Stem Trauma

Hypertonic saline: First-line therapy for cerebral edema?

“…Brain stem auditory evoked potentials were unchanged. It is arguable that the transient clinical improvement was the result of improved perfusion alone in this case because the peak serum sodium level was only 143 mEq/L (serum osmolarity of 292 mosM/L) although treatment with 5.4% HS concentration produced the best improvement in motor function [64].…”

Cerebral resuscitation: role of osmotherapy

“…This group described two patients with elevated ICP refractory to mannitol, who were treated successfully with a single bolus of 30% saline, after which ICP decreased and systemic perfusion improved. In another report, continuous infusion of 2.5% and 5.4% saline enhanced CPP and improved somatosensory evoked potentials in a patient with brain stem trauma [16]. Likewise, in an uncontrolled, nonrandomized study [40], there were reductions in ICP with a 7.5% HS solution after neurotrauma.…”

“…Through the years, a variety of osmotic agents have been utilized for this purpose in a variety of acute brain injury paradigms [5,13]. These agents include urea, mannitol, glycerol, sorbitol [13,14], and, more recently, HS solutions [5,[14][15][16]. Weed and McKibben [17] were the first to describe the effects of administering intravenous osmotic agents on the brain.…”

Hypertonic saline for cerebral edema

“…Hypertonic saline has been reported as having a beneficial effect on elevated ICP in patients after TBI, but there is still no agreement on its appropriate use [22][23][24][25][26][27][28][29][30][31][32][33]. For instance, the case report by Gemma et al [25] was accompanied by two further articles discussing differing points of view regarding the use of HS in TBI [26,27].…”

“…For instance, the case report by Gemma et al [25] was accompanied by two further articles discussing differing points of view regarding the use of HS in TBI [26,27]. One of them recommended the use of HS in neurosurgical patients [27], whereas the other concluded that, until the risk-benefit ratio of these solutions are better defined in humans, they should not be used [26].…”