Ethan J Sabers1, Pamela D Reiter2, Heather E Skillman3, Gina DeMasellis4. 1. Clinical Pharmacist, Acute Pharmaceutical Care, Department of Pharmaceutical Care, University of Iowa Stead Family Children's Hospital, University of Iowa Health Care , Iowa City, IA, USA. 2. Clinical Pharmacy Specialist, Department of Pharmacy and Division of Pediatric Critical Care, Department of Clinical Pharmacy (Anschutz Medical Campus), Children's Hospital Colorado Clinical Professor, Skaggs School of Pharmacy and Pharmaceutical Sciences , Aurora, CO, USA. 3. Department of Clinical Nutrition, Children's Hospital Colorado, Anschutz Medical Campus , Aurora, CO, USA. 4. School of Medicine, Department of Pediatrics, Division of Pediatric Critical Care, Children's Hospital Colorado and University of Colorado Denver , Aurora, CO, USA.
Abstract
OBJECTIVE: Describe outcomes associated with bolus and continuous infusions of hypertonic saline (HTS) in children with severe traumatic brain injury (TBI). METHODS: IRB-approved, single-center, retrospective review of children admitted between January 1, 2012 to August 30, 2018 with a diagnosis of severe TBI who received HTS. RESULTS: Forty-five children (age 9.3 ± 5.8 yr; 60% male) met inclusion criteria. One-hundred eighty-nine equiosmolar bolus doses of HTS were administered to 43 patients (3% HTS, n = 84 doses; 6% HTS, n = 38 doses; 12% HTS, n = 67 doses) for episodes of acute intracranial hypertension (pressure above 20 mmHg). Significant reductions in ICP were observed at 30, 60, and 120 min following HTS boluses with the greatest decrease observed in patients receiving 12%. Thirty-four patients received a continuous infusion of HTS. Higher concentrations of HTS were associated with a more favorable fluid balance (p < .001), fewer episodes of pulmonary edema (p = .003), and higher intake of protein and energy (p < .001). CONCLUSIONS: Equiosmolar bolus doses of concentrated HTS were associated with significant reductions in ICP. Benefits of higher concentrations of continuous HTS may include improved fluid balance, less pulmonary edema, and greater amounts of protein and energy intake.
OBJECTIVE: Describe outcomes associated with bolus and continuous infusions of hypertonic saline (HTS) in children with severe traumatic brain injury (TBI). METHODS: IRB-approved, single-center, retrospective review of children admitted between January 1, 2012 to August 30, 2018 with a diagnosis of severe TBI who received HTS. RESULTS: Forty-five children (age 9.3 ± 5.8 yr; 60% male) met inclusion criteria. One-hundred eighty-nine equiosmolar bolus doses of HTS were administered to 43 patients (3% HTS, n = 84 doses; 6% HTS, n = 38 doses; 12% HTS, n = 67 doses) for episodes of acute intracranial hypertension (pressure above 20 mmHg). Significant reductions in ICP were observed at 30, 60, and 120 min following HTS boluses with the greatest decrease observed in patients receiving 12%. Thirty-four patients received a continuous infusion of HTS. Higher concentrations of HTS were associated with a more favorable fluid balance (p < .001), fewer episodes of pulmonary edema (p = .003), and higher intake of protein and energy (p < .001). CONCLUSIONS: Equiosmolar bolus doses of concentrated HTS were associated with significant reductions in ICP. Benefits of higher concentrations of continuous HTS may include improved fluid balance, less pulmonary edema, and greater amounts of protein and energy intake.
Authors: Patrick M Kochanek; P David Adelson; Bedda L Rosario; James Hutchison; Nikki Miller Ferguson; Peter Ferrazzano; Nicole O'Brien; John Beca; Ajit Sarnaik; Kerri LaRovere; Tellen D Bennett; Akash Deep; Deepak Gupta; F Anthony Willyerd; Shiyao Gao; Stephen R Wisniewski; Michael J Bell Journal: JAMA Netw Open Date: 2022-03-01