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Effects of 23.4% sodium chloride solution in reducing intracranial pressure in patients with traumatic brain injury: a preliminary study.
Neurosurgery 2005; 57(4):727-36; discussion 727-36N

Abstract

OBJECTIVE

Mannitol is the standard of care for patients with increased intracranial pressure (ICP), but multiple administrations of mannitol risk renal toxicity and fluid accumulation in the brain parenchyma with consequent worsening of cerebral edema. This preliminary study assessed the safety and efficacy of small-volume injections of 23.4% sodium chloride solution for the treatment of intracranial hypertension in patients with traumatic brain injury who became tolerant to mannitol.

METHODS

We retrospectively reviewed the charts of 13 adult patients with traumatic brain injury who received mannitol and 23.4% sodium chloride independently for the treatment of intracranial hypertension at San Francisco General Hospital between January and October 2003. Charts were reviewed to determine ICP, cerebral perfusion pressure, mean arterial pressure, serum sodium values, and serum osmolarity before and after treatment with 23.4% sodium chloride and mannitol. Complications were noted.

RESULTS

The mean reductions in ICP after treatment were significant for both mannitol (P < 0.001) and hypertonic saline (P < 0.001); there were no significant differences between reductions in ICP when comparing the two agents (P = 0.174). The ICP reduction observed for hypertonic saline was durable, and its mean duration of effect (96 min) was significantly longer than that of mannitol treatment (59 min) (P = 0.016). No complications were associated with treatment with hypertonic saline.

CONCLUSION

This study suggests that 23.4% hypertonic saline is a safe and effective treatment for elevated ICP in patients after traumatic brain injury. These results warrant a rigorous evaluation of its efficacy as compared to mannitol in a prospective randomized controlled trial.

Authors+Show Affiliations

Department of Neurological Surgery, University of California, San Francisco, California 94110, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, P.H.S.

Language

eng

PubMed ID

16239885

Citation

Ware, Marcus L., et al. "Effects of 23.4% Sodium Chloride Solution in Reducing Intracranial Pressure in Patients With Traumatic Brain Injury: a Preliminary Study." Neurosurgery, vol. 57, no. 4, 2005, pp. 727-36; discussion 727-36.
Ware ML, Nemani VM, Meeker M, et al. Effects of 23.4% sodium chloride solution in reducing intracranial pressure in patients with traumatic brain injury: a preliminary study. Neurosurgery. 2005;57(4):727-36; discussion 727-36.
Ware, M. L., Nemani, V. M., Meeker, M., Lee, C., Morabito, D. J., & Manley, G. T. (2005). Effects of 23.4% sodium chloride solution in reducing intracranial pressure in patients with traumatic brain injury: a preliminary study. Neurosurgery, 57(4), pp. 727-36; discussion 727-36.
Ware ML, et al. Effects of 23.4% Sodium Chloride Solution in Reducing Intracranial Pressure in Patients With Traumatic Brain Injury: a Preliminary Study. Neurosurgery. 2005;57(4):727-36; discussion 727-36. PubMed PMID: 16239885.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Effects of 23.4% sodium chloride solution in reducing intracranial pressure in patients with traumatic brain injury: a preliminary study. AU - Ware,Marcus L, AU - Nemani,Venu M, AU - Meeker,Michele, AU - Lee,Currie, AU - Morabito,Diane J, AU - Manley,Geoffrey T, PY - 2005/10/22/pubmed PY - 2006/7/14/medline PY - 2005/10/22/entrez SP - 727-36; discussion 727-36 JF - Neurosurgery JO - Neurosurgery VL - 57 IS - 4 N2 - OBJECTIVE: Mannitol is the standard of care for patients with increased intracranial pressure (ICP), but multiple administrations of mannitol risk renal toxicity and fluid accumulation in the brain parenchyma with consequent worsening of cerebral edema. This preliminary study assessed the safety and efficacy of small-volume injections of 23.4% sodium chloride solution for the treatment of intracranial hypertension in patients with traumatic brain injury who became tolerant to mannitol. METHODS: We retrospectively reviewed the charts of 13 adult patients with traumatic brain injury who received mannitol and 23.4% sodium chloride independently for the treatment of intracranial hypertension at San Francisco General Hospital between January and October 2003. Charts were reviewed to determine ICP, cerebral perfusion pressure, mean arterial pressure, serum sodium values, and serum osmolarity before and after treatment with 23.4% sodium chloride and mannitol. Complications were noted. RESULTS: The mean reductions in ICP after treatment were significant for both mannitol (P < 0.001) and hypertonic saline (P < 0.001); there were no significant differences between reductions in ICP when comparing the two agents (P = 0.174). The ICP reduction observed for hypertonic saline was durable, and its mean duration of effect (96 min) was significantly longer than that of mannitol treatment (59 min) (P = 0.016). No complications were associated with treatment with hypertonic saline. CONCLUSION: This study suggests that 23.4% hypertonic saline is a safe and effective treatment for elevated ICP in patients after traumatic brain injury. These results warrant a rigorous evaluation of its efficacy as compared to mannitol in a prospective randomized controlled trial. SN - 1524-4040 UR - https://www.unboundmedicine.com/medline/citation/16239885/Effects_of_23_4_sodium_chloride_solution_in_reducing_intracranial_pressure_in_patients_with_traumatic_brain_injury:_a_preliminary_study_ L2 - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&amp;PAGE=linkout&amp;SEARCH=16239885.ui DB - PRIME DP - Unbound Medicine ER -