OBJECTIVE: 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. INTERVENTIONS: Intravenous infusion of 3% hypertonic saline to increase serum sodium to levels necessary to reduce ICP < or =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.
OBJECTIVE: To determine the effects continuous infusions of hypertonicsaline (3% NaCl) on intracranial pressure (ICP) control and describe the physiologic effects of hypertonicsaline administered to closed head injurychildren. DESIGN: Retrospective chart review. SETTINGS: Pediatric intensive care unit of a children's hospital. PATIENTS: Sixty-eight children with closed head injury. INTERVENTIONS: Intravenous infusion of 3% hypertonicsaline to increase serum sodium to levels necessary to reduce ICP < or =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:Hypertonicsaline 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.
Authors: Rick M Odland; Sandya Venugopal; John Borgos; Valerie Coppes; Alexander M McKinney; Gaylan Rockswold; Jian Shi; Scott Panter Journal: Neurosurgery Date: 2012-02 Impact factor: 4.654