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

Abstract

Background Traumatic brain injury (TBI) causes mortality and long-term disability among young adults and imposes a notable cost on the healthcare system. In addition to the first physical hit, secondary injury, which is associated with increased intracranial pressure (ICP), is defined as biochemical, cellular, and physiological changes after the physical injury. Mannitol and Hypertonic saline (HTS) are the treatment bases for elevated ICP in TBI. This systematic review and meta-analysis evaluates the effectiveness of HTS in the management of patients with TBI. Methods This study was conducted following the Joanna Briggs Institute (JBI) methods and PRISMA statement. A systematic search was performed through six databases in February 2022, to find studies that evaluated the effects of HTS, on increased ICP. Meta-analysis was performed using comprehensive meta-analysis (CMA). Results Out of 1321 results, 8 studies were included in the systematic review, and 3 of them were included in the quantitative synthesis. The results of the meta-analysis reached a 35.9% (95% CI 15.0–56.9) reduction in ICP in TBI patients receiving HTS, with no significant risk of publication bias (t-value = 0.38, df = 2, p-value = 0.73). The most common source of bias in our included studies was the transparency of blinding methods for both patients and outcome assessors. Conclusion HTS can significantly reduce the ICP, which may prevent secondary injury. Also, based on the available evidence, HTS has relatively similar efficacy to Mannitol, which is considered the gold standard therapy for TBI, in boosting patients' neurological condition and reducing mortality rates.

Cell volume tunes macrophage innate inflammatory responses through promoting type I interferon signalling

“…In our experiments we observe that the VRAC-dependent RVD is important for NLRP3 activation in response to severe hypo-osmotic stress 9 , and that in response to milder hypoosmotic stress VRAC-dependent RVD appears to restrain inflammatory responses, highlighting a complex regulation of inflammation by cell volume change. Therapeutically, hyperosmotic solutions have been utilised to treat several conditions, predominantly following acute brain injury to reduce cerebral oedema [50][51][52][53][54][55] ), but also as part of treatment for cystic fibrosis 56 , asthma 57 , bronchiectasis 58 , COVID-19 59 , and for resuscitation of critically ill patients 60 . Further, treatment with hyperosmotic solutions has been shown to limit inflammatory disease in pre-clinical disease models, including kainite-induced brain injury 36 , sepsis 15 , intracerebral haemorrhage 16 , pulmonary injury due to ischaemia-reperfusion 17 , and acute respiratory distress syndrome (ARDS) 18 , suggesting that manipulation of cell volume regulation could be harnessed to target disease processes.…”

Prehospital Predictors for Urgent Neurosurgical Intervention in the Head Trauma Patient: A 2-Year Multicenter Retrospective Study

“…Head trauma is one of the main causes of death in trauma patients. In North America, TBI kills 7 patients every hour [ 2 , 4 ]. Although exact number is hard to determine, it is assessed that TBI affects 27–69 million people and their families every year [ 6 , 7 ].…”

“…Until recently, TBI patients were mostly young men involved in road traffic collision (RTC), while the current data show that almost one-third of TBI patients are people aged over 75, who suffer a fall. This age group also accounts for 32% of TBI-related hospitalizations and 28% of deaths [ 4 ]. Therefore, each year an estimated 69 million individuals will suffer a TBI, the vast majority of which will be mild (81%) or moderate (11%) in severity.…”

Traumatic brain injuries in sport: A systematic review

“…Po globalnim podacima više od 50 miliona ljudi godišnje pretrpi neki oblik TBI, (Maas et al, 2017), a veliki deo preživelih ima posttraumatske komplikacije u vidu neuroloških, psihosocijalnih poremećaja i invaliditeta različitog trajanja i stepena (NG & Lee, 2019). Ukoliko se nakon primarnih simptoma razviju sekundarne promene na biohemijskom, ćelijskom i fiziološkom nivou, dolazi do razvoja višeg stepena neurološkog deficita i povećane stope mortaliteta (Gharizadeh et al, 2022). Simptomi koji ukazuju na razvoj sekundarnih promena mogu biti različitog trajanja; ako traju duže od tri meseca postavlja se dijagnoza postkomocionog sindroma.…”

“…1 Hiperosmolarna terapija: podrazumeva primenu manitola i hipertoničnog fiziološkog ratstvora u cilju smanjenja intrakranijalnog pritiska (Gharizadeh et al, 2022). ).…”