The Use of Hypertonic Saline for Treating Intracranial Hypertension After Traumatic Brain Injury
Hayden White,* David Cook,† and Bala Venkatesh†
(Anesth Analg, 102:1836-1846, 2006)
*Department of Anesthesiology, Queen Elizabeth II Hospital; and †Department of Intensive Care, Princess Alexandra Hospital, University of Queensland, Brisbane, Australia
The past decade has seen a resurgence of interest in the use of hypertonic saline (HTS) for low-volume resuscitation after trauma. Preliminary studies suggested that benefits are limited to a subgroup of trauma patients with brain injury. However, a recent study of prehospital administration of HTS to patients with traumatic brain injury (TBI) failed to confirm a benefit. Animal and human studies have demonstrated that HTS has clinically desirable physiological effects on cerebral blood flow, intracranial pressure (ICP), and inflammatory responses in models of neurotrauma. There are few clinical studies in TBI with patient survival as an end point. In this review, the authors examine the experimental and clinical knowledge of HTS as an osmotherapeutic agent in neurotrauma.