Hypertonic Saline for Moderate Traumatic Brain Injury: A Scoping Review of Impact on Neurological Deterioration

Abstract

Hypertonic saline (HTS) is a commonly administered agent for intracranial pressure (ICP) control in traumatic brain injury (TBI). The literature on its use is mainly in moderate/severe TBI where invasive ICP monitoring is present. The role of HTS in patients with moderate TBI (mTBI) outside of the intensive care unit (ICU) setting remains unclear. The goal of this scoping review was to provide an overview of the available literature on HTS administration in patients with mTBI without ICP monitoring, assessing its impact on outcome and transitions in care. We performed a scoping systematic review of the literature of MEDLINE, Embase, Scopus, BIOSIS, and the Cochrane Databases from inception to July 31, 2020. We searched for those published articles documenting the administration of HTS in patients with mTBI with recorded functional outcome or transitions in hospital care. A two-step review process was conducted in accordance with methodology outlined in the Cochrane Handbook for Systematic Reviews of Interventions . There were many studies with combined moderate/severe TBI populations. However, most failed to document subgroup analysis for patients with mTBI. Our search strategy identified only one study that documented the administration of HTS in mTBI in which subgroup analysis for mTBI and outcomes were provided. This retrospective cohort study assessed patients with mTBI who did/did not receive prophylactic HTS, finding that those not receiving HTS demonstrated a deterioration in Glasgow Coma Scale (GCS) score in the first 48 h. However, the HTS group did demonstrate a trend to longer hospital stay and pneumonia. Our scoping review identified a significant gap in knowledge surrounding the use of HTS for patients with mTBI without invasive ICP monitoring. The limited identified literature suggests prophylactic administration prevents clinical deterioration, although this is based on a single study with data available for mTBI sub-analysis. Further studies on HTS in non-monitored patients with mTBI are required.

Hypertonic saline for traumatic brain injury: a systematic review and meta-analysis

“…Despite the absence of Class 1 evidence, ICP monitoring is suggested as a standard clinical observation in TBI patients [ 37 ]. A recent scoping review found the evidence regarding the HTS usage in patients with moderate TBI without ICP monitoring inconclusive [ 38 ]. We investigated the role of HTS in controlling ICP as the primary outcome and we found that HTS can significantly reduce the ICP in patients with TBI.…”

Comparative Evaluation of Efficacy of Mannitol and Hypertonic Saline (3%) for Treatment of Moderate to Severe Traumatic Brain Injury (TBI)

“…Not only is it cheaper, but is also as efficacious as Mannitol [36]. It also has lower Blood Brain Barrier permeability and lesser side effects than Mannitol [37]. The recommended dose is from one-foru mL/kg [38].…”

Protective effect of dexmedetomidine pre treatment against myocardial ischemia reperfusion injury in rats

“…Hypertonic saline maintains normovolemia and cerebral perfusion [1]. Prophylactic use of a hypertonic agent is not recommended for mannitol, but this is possible with hypertonic saline [14]. In a study, the osmolarity values of 3 % (w/v) hypertonic saline, 20 % (w/v) mannitol, and 10 % (w/v) mannitol plus 10 % (v/v) glycerol were 1027, 1100 and 1049 mOsm/L, respectively [1].…”