Hypertonic saline

Todd Fraser on 09-05-2012

Hypertonic saline seems to be it and a bit in the world of neurocritical care. It appears in many clinical pathways for the management of intracerebral catastrophes such as traumatic brain injury and subarachnoid haemorrhage, yet the only large scale randomised controlled trial, performed pre-hospital for TBI, has found no differences in important clinical outcomes. Additionally, there appears to be no consensus in dosing. In a limited survey of available protocols, the recommended dose varied almost 10-fold. This extraordinary variability, and the lack of research in this area, is difficult to understand given that traumatic brain injury is so common.

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Jo Butler wrote 05-18-2012 10:19:13 am
Its very difficult to tease out dosing in the studies available.

As you say, the only RCT in this area does not seem to show a benefit from 250ml of 3%. I know Queensland Ambulance Service have adopted a much higher dose - 250ml of 7.5%.

Is it likely that higher dosing will improve outcomes? Is the intent to use it as an osmotic agent or a resuscitative fluid?

It seems that its being widely adopted largely on the back of experimental data only.

Ian Seppelt wrote 05-21-2012 04:21:02 pm
Careful you are not comparing apples with watermelons.

Jamie Cooper's (JAMA 2004) and Eileen Bulger's trials (Ann Surg 2011) were fluid resuscitation trials, in TBI and general trauma cohorts respectively. This is a totally different question to the use of HTS as osmotherapy in intracranial hypertension where the question is basically HTS vs mannitol (and in my reading of the literature HTS wins hands down)