To determine the effects continuous infusions of hypertonic saline (3% NaCl) on intracranial pressure (ICP) control and describe the physiologic effects of hypertonic saline administered to closed head injury children.Design:
Retrospective chart review.Settings:
Pediatric intensive care unit of a children's hospital.Patients:
Sixty-eight children with closed head injury.Intervention:
Intravenous infusion of 3% hypertonic saline to increase serum sodium to levels necessary to reduce ICP ≤20 mm Hg.Measurements and Main Results:
The patients enrolled had similar Injury Severity Scores. Treatment effectively lowered ICP in these patients and ICP was under good control a majority of the time. Only three patients (4%) died of uncontrolled elevation of ICP. No adverse effects of supraphysiologic hyperosmolarity such as renal failure, pulmonary edema, or central pontine demyelination, were noted.Conclusions:
Hypertonic saline administration to children with closed head injury appears to be a promising therapy for control of cerebral edema. Further controlled trials are required to determine the optimal duration of treatment before widespread use is advocated.