Cerebral edema: Hypertonic saline solutions
- 256 Downloads
Our experience, and that of others, suggests that hypertonic saline solution therapy reduces intracranial pressure and lateral displacement of the brain in patients with cerebral edema. This therapy appears most promising in patients who have head trauma or postoperative cerebral edema. Studies comparing hypertonic saline therapy with conventional therapies are limited. Additional randomized studies are needed to determine its safety and optimum duration of benefit and to determine the lesions most likely to be improved. To date, the cost effectiveness of hypertonic saline therapy is unknown. Caution is advised regarding its use until the results of more definitive trials investigating its efficacy and safety are known.
Unable to display preview. Download preview PDF.
References and Recommended Readings
- 2.Zornow MH: Hypertonic saline as a safe and efficacious treatment of intracranial hypertension. J Neurosurg Anesthesiol 1996, 8:175–177. This article reviews the history, pathophysiologic basis, experimental evidence, and clinical study results of the use of hypertonic saline solutions for the treatment of intracranial hypertension.PubMedGoogle Scholar
- 3.Weed LH, McKibben PS: Experimental alteration of brain bulk. Am J Physiol 1919, 48:531–555.Google Scholar
- 8.Denchev D, Schnitzer M, Mirski M, et al.: Treatment of elevated intracranial pressure in an experimental awake model of focal cerebral injury: comparison between mannitol and hypertonic saline. In Intracranial Pressure IX. Edited by Ngai H, Kamiya K, Ishii S. Tokyo: Springer-Verlag; 1994:658–659.Google Scholar
- 22.Suarez JI, Qureshi AI, Bhardwaj A, et al.: Treatment of refractory intracranial hypertension with 23.4% saline. Crit Care Med 1998, 26:1118–1122. This article presents the results of a case series of patients with intracranial hypertension refractory to treatment by conventional therapies. Intravenous boluses (30 mL) of 23.4% saline reduced intracranial pressure and augmented cerebral perfusion pressure for several hours in these patients.PubMedCrossRefGoogle Scholar
- 24.Simma B, Burger R, Falk M, et al.: A prospective, randomized, and controlled study of fluid management in children with severe head injury: lactated Ringer’s solution versus hypertonic saline. Crit Care Med 1998, 26:1265–1270. This article describes a prospective, randomized, controlled trial of lactated Ringer’s or hypertonic saline therapy after severe traumatic brain injury in children. Patients administered hypertonic saline had lower levels of intracranial pressure and cerebral perfusion pressure, fewer complications, and shorter intensive care unit stays.PubMedCrossRefGoogle Scholar