Brain Edema X pp 126-129 | Cite as
Hypertonk/Hyperoncotic Saline Reliably Reduces ICP in Severely Head-Injured Patients with Intracranial Hypertension
Conference paper
Summary
Hypertonic saline (HS) has been shown to decrease intracranial pressure (ICP) and cerebral water content in experimental models of traumatic brain injury (TBI). The purpose of the present study was to test the efficacy of administration of HS (7,5%) combined with 6% hydroxyethyl starch (molecular weight 200.000/0.60–0.66; HHES) for the treatment of therapy-resistant intracranial hypertension in patients with severe TBI. Six patients with severe TBI (GCS < 8) who met the inclusion criteria (therapy resistant ICP > 25 mmHg, cerebral perfusion pressure (CPP) < 60 mmHg, plasma-Na+ < 150 mOsm and > 4 hours since the last HS/HHES treatment) were prospectively enrolled in the study and received between one and ten bolus infusions of maximal 250 ml HS/HHES at a rate of 20 ml/min. A total of 32 infusions were given.
Administration of HS/HHES significantly lowered ICP by 44% and improved CPP by 38% to well above 70 mmHg at 30 min without affecting arterial blood pressure or blood gases. Plasma sodium normalized within 30 min. Experimental studies from our laboratory indicate that the ICPlowering effect is primarily due to dehydration of brain tissue and that cerebral blood volume remains largely unaffected by HS.
In summary, HS/HHES reduces otherwise therapy-resistant intracranial hypertension and improves cerebral perfusion even after repeated administration without negatively affecting blood pressure or causing a rebound ICP increase.
Keywords
Head injury hypertonic saline small-volume resuscitation colloids intracranial pressurePreview
Unable to display preview. Download preview PDF.
References
- 1.Battistella F, Wisner D (1992) Cerebral dehydration following hypertonic saline resuscitation. Circ Shock 37: 16Google Scholar
- 2.Battistella FD, Wisner DH (1991) Combined hemorrhagic shock and head injury: effects of hypertonic saline (7.5%) resuscitation. J Trauma 31:182–188PubMedGoogle Scholar
- 3.Berger S, Schürer L, Härtl R, et al (1995) Reduction of posttraumatic intracranial hypertention by hypertonic/hyperoncotic saline/dextran and mannitol. Neurosurgery 37: 98–108PubMedCrossRefGoogle Scholar
- 4.Bullock R, Chesnut R, Clifton G, et al (1995) Guidelines for the management of severe head injury. J.S.o.N.a.C.C. AANS Brain Trauma Foundation, New YorkGoogle Scholar
- 5.Fisher B, Thomas D, Peterson B (1992) Hypertonic saline lowers raised ICP in children after head trauma. J Neurosurg Anesth 4:4–10CrossRefGoogle Scholar
- 6.Gunnar WP, Merlotti GJ, Barrett J, et al (1986) Resuscitation from hemorrhagic shock. Alterations of the intracranial pressure after normal saline, 3% saline and dextran -40. Ann Surg 204: 686–692PubMedCrossRefGoogle Scholar
- 7.Härtl R, Cohen D, Medary M, et al (1995) Effect of hypertonic saline/dextran on intracranial pressure, cerebral blood volume and brain edema after traumatic brain injury in pigs. J Neuro-trauma 12: 416 (Abstract)Google Scholar
- 8.Härtl R, Schürer L, Dautermann C, et al (1993) Effect of hypertonic-hyperoncotic solutions (HHS) on increased ICP after a focal brain lesion and inflation of an intracranial balloon. In: Avezaat CJJ (ed) Intracranial pressure VIII. Springer, Berlin Heidelberg New York Tokyo, pp 612–614Google Scholar
- 9.Härtl R, Schürer L, Goetz C, et al (1995) The effect of hypertonic fluid resuscutation on brain edema in rabbits subjected to brain injury and hemorrhagic shock. Shock 3: 274–279PubMedCrossRefGoogle Scholar
- 10.Kreimeier U, Brueckner UB, Schmidt J, et al (1990) Instantaneous restoration of regional organ blood flow after severe hemorrhage: effect of small-volume resuscitation with hypertonic-hyperoncotic solutions. J Surg Res 49: 493–503PubMedCrossRefGoogle Scholar
- 11.Kuhl DE, Alavi A, Hoffman EJ, et al (1980) Local cerebral blood volume in head-injured patients. Determination by emission computed tomography of 99mTc-labeled red cells. J Neurosurg 52:309–320PubMedCrossRefGoogle Scholar
- 12.Mattox KL, Maningas PA, Moore EE, et al (1991) Prehospital hypertonic saline/dextran infusion for post-traumatic hypotension. The U.S.A. Multicenter Trial. Ann Surg 213: 482–491PubMedCrossRefGoogle Scholar
- 13.Meier-Hellmann A, Hannemann L, Kuss B, et al (1990) Treatment of therapy resistant ICP by application of hypertonic saline. Eur Surg Res 22: 303–304Google Scholar
- 14.Muizelaar JP, Lutz HA, Becker DP (1984) Effect of mannitol on ICP and CBF and correlation with pressure autoregulation in severely head-injured patients. J Neurosurg 61: 700–706PubMedCrossRefGoogle Scholar
- 15.Muizelaar JP, Wei EP, Kontos HA, et al (1983) Mannitol causes compensatory cerebral vasoconstriction and vasodilation in response to blood viscosity changes. J Neurosurg 59: 822–828PubMedCrossRefGoogle Scholar
- 16.Prough DS, Whitley JM, Taylor CL, et al (1991) Regional cerebral blood flow following resuscitation from hemorrhagic shock with hypertonic saline. Influence of a subdural mass [see comments]. Anesthesiology 75: 319–327PubMedCrossRefGoogle Scholar
- 17.Schürer L, Dautermann C, Härtl R, et al (1992) Treatment of hemorrhagic hypotension with hypertonic/hyperoncotic solutions: effects on regional cerebral blood flow and brain surface oxygen tension. Eur Surg Res 24: 1–12PubMedGoogle Scholar
- 18.Shackford SR, Norton CH, Todd MM (1988) Renal, cerebral, and pulmonary effects of hypertonic resuscitation in a porcine model of hemorrhagic shock. Surgery 104: 553–560PubMedGoogle Scholar
- 19.Shackford SR, Schmöker JD, Zhuang J (1994) The effect of hypertonic resuscitation on pial arteriolar tone after brain injury and shock. J Trauma 37: 899–908PubMedCrossRefGoogle Scholar
- 20.Shackford SR, Zhuang J, Schmöker J (1992) Intravenous fluid tonicity: effect on intracranial pressure, cerebral blood flow, and cerebral oxygen delivery in focal brain injury. J Neurosurg 76: 91–98PubMedCrossRefGoogle Scholar
- 21.Vassar MJ, Fischer RP, O’Brien PE, et al (1993) A multicenter trial for resuscitation of injured patients with 7.5% sodium chloride. The effect of added dextran 70. The Multicenter Group for the Study of Hypertonic Saline in Trauma Patients. Arch Surg 128: 1003–1011PubMedGoogle Scholar
- 22.Vassar MJ, Perry CA, Gannaway WL, et al (1991) 7.5% sodium chloride/dextran for resuscitation of trauma patients undergoing helicopter transport. Arch Surg 126: 1065–1072PubMedGoogle Scholar
- 23.Vassar MJ, Perry CA, Holcroft JW (1990) Analysis of potential risks associated with 7.5% sodium chloride resuscitation of traumatic shock [published erratum appears in Arch Surg 1991 126 (1): 43]. Arch Surg 125: 1309–1315PubMedGoogle Scholar
- 24.Vassar MJ, Perry CA, Holcroft JW (1993) Prehospital resuscitation of hypotensive trauma patients with 7.5% NaCl versus 7.5% NaCl with added dextran: a controlled trial. J Trauma 34: 622–632PubMedCrossRefGoogle Scholar
- 25.Walsh JC, Zhuang J, Shackford SR (1991) A comparison of hypertonic to isotonic fluid in the resuscitation of brain injury and hemorrhagic shock. J Surg Res 50: 284–292PubMedCrossRefGoogle Scholar
- 26.Wisner D, Busche F, Sturm J, et al (1989) Traumatic shock and head injury: effects of fluid resuscitation on the brain. J Surg Res 46: 49–59PubMedCrossRefGoogle Scholar
- 27.Wisner DH, Schuster L, Quinn C (1990) Hypertonic saline resuscitation of head injury: effects on cerebral water content. J Trauma 30: 75–78PubMedCrossRefGoogle Scholar
- 28.Worthley LI, Cooper DJ, Jones N (1988) Treatment of resistant intracranial hypertension with hypertonic saline. Report of two cases. J Neurosurg 68: 478–481PubMedCrossRefGoogle Scholar
- 29.Zornow MH, Serieller MS, Shackford SR (1989) Effect of a hypertonic lactated Ringer’s solution on intracranial pressure and cerebral water content in a model of traumatic brain injury. J Trauma 29: 484–488PubMedCrossRefGoogle Scholar
Copyright information
© Springer-Verlag 1997