Hypertonic saline infusion for treating intracranial hypertension after severe traumatic brain injury

Critical Care : the Official Journal of the Critical Care Forum
Halinder S Mangat

Abstract

Traumatic brain injury (TBI) remains a major cause of mortality and disability. Post-traumatic intracranial hypertension (ICH) further complicates the care of patients. Hyperosmolar agents are recommended for the treatment of ICH, but no consensus or high-level data exist on the use of any particular agent or the route of administration. The two agents used commonly are hypertonic saline (HTS) and mannitol given as bolus therapy. Smaller studies suggest that HTS may be a superior agent in reducing the ICH burden, but neither agent has been shown to improve mortality or functional outcome. In a recently published analysis of pooled data from three prospective clinical trials, continuous infusion of HTS correlated with serum hypernatremia and reduced ICH burden in addition to improving 90-day mortality and functional outcome. This lays the foundation for the upcoming continuous hyperosmolar therapy for traumatic brain-injured patients (COBI) randomized controlled trial to study the outcome benefit of continuous HTS infusion to treat ICH after severe TBI. This is much anticipated and will be a high impact trial should the results be replicated. However, this would still leave a question over the use of mannitol bolus therapy which...Continue Reading

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Citations

May 17, 2019·Expert Review of Neurotherapeutics·Ranier ReyesVenkatesh Aiyagari
Mar 12, 2019·Current Opinion in Critical Care·Ségolène MrozekThomas Geeraerts
Jun 18, 2019·Current Surgery Reports·Henry W Caplan, Charles S Cox
Jul 27, 2021·Frontiers in Veterinary Science·Armi Pigott, Elke Rudloff

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Clinical Trials Mentioned

NCT03143751

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Brain Injury & Trauma

brain injury after impact to the head is due to both immediate mechanical effects and delayed responses of neural tissues.