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Hypertonic saline (7.2%) in 6% hydroxyethyl starch reduces intracranial pressure and improves hemodynamics in a placebo-controlled study involving stable patients with subarachnoid hemorrhage.
Crit Care Med. 2006 Dec; 34(12):2912-7.CC

Abstract

OBJECTIVE

To compare the effects of a bolus infusion of hypertonic saline hydroxyethyl starch with the effects of normal saline (placebo) on intracranial pressure (ICP) and cerebral perfusion pressure in patients with spontaneous subarachnoid hemorrhage.

DESIGN AND SETTING

Prospective, randomized, single-blinded, placebo-controlled study in a university hospital.

PATIENTS

A total of 22 mechanically ventilated patients with spontaneous subarachnoid hemorrhage with stable ICP between 10 and 20 mm Hg.

INTERVENTIONS

During the course of 30 mins, 2 mL/kg of either 7.2% saline in 6% hydroxyethyl starch 200/0.5 (HSS) or of normal saline was infused. The effects were observed for another 180 mins.

MEASUREMENTS AND MAIN RESULTS

Mean change in ICP after intervention (DeltaICP) calculated from the average of all observations was -3.3 (sd 2.6) mm Hg in the HSS group vs. -0.3 (sd 1.3) mm Hg in the normal saline group. Mean difference between the groups (HSS - normal saline) was -3.0 mm Hg (95% confidence interval, -4.9 to -1.1; p = .004). Mean peak change after HSS was -5.6 (range, -0.8 to -12.2) mm Hg after 64 (range, 40 to 115) mins. Mean difference in cerebral perfusion pressure change between the groups (HSS - normal saline) was 5.4 mm Hg (95% confidence interval, 2.2 to 8.6; p = .002), and mean difference in cardiac index change, measured as the area under the curve for the whole study period, corresponded to 0.2 L.min.m (95% confidence interval, 0.03 to 0.4; p = .025).

CONCLUSIONS

In this placebo-controlled study involving spontaneous subarachnoid hemorrhage patients with normal to moderately increased ICP, 2 mL/kg HSS reduced ICP and increased cerebral perfusion pressure significantly. Maximum effect was reached at twice the infusion time of 30 mins. There were also beneficial hemodynamic effects with increased cardiac index in the HSS group.

Authors+Show Affiliations

Department of Anesthesiology and Intensive Care, Rikshospitalet-Radiumhospitalet Medical Center, Faculty of Medicine, University of Oslo, Oslo, Norway.No affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Randomized Controlled Trial

Language

eng

PubMed ID

17075367

Citation

Bentsen, Gunnar, et al. "Hypertonic Saline (7.2%) in 6% Hydroxyethyl Starch Reduces Intracranial Pressure and Improves Hemodynamics in a Placebo-controlled Study Involving Stable Patients With Subarachnoid Hemorrhage." Critical Care Medicine, vol. 34, no. 12, 2006, pp. 2912-7.
Bentsen G, Breivik H, Lundar T, et al. Hypertonic saline (7.2%) in 6% hydroxyethyl starch reduces intracranial pressure and improves hemodynamics in a placebo-controlled study involving stable patients with subarachnoid hemorrhage. Crit Care Med. 2006;34(12):2912-7.
Bentsen, G., Breivik, H., Lundar, T., & Stubhaug, A. (2006). Hypertonic saline (7.2%) in 6% hydroxyethyl starch reduces intracranial pressure and improves hemodynamics in a placebo-controlled study involving stable patients with subarachnoid hemorrhage. Critical Care Medicine, 34(12), 2912-7.
Bentsen G, et al. Hypertonic Saline (7.2%) in 6% Hydroxyethyl Starch Reduces Intracranial Pressure and Improves Hemodynamics in a Placebo-controlled Study Involving Stable Patients With Subarachnoid Hemorrhage. Crit Care Med. 2006;34(12):2912-7. PubMed PMID: 17075367.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Hypertonic saline (7.2%) in 6% hydroxyethyl starch reduces intracranial pressure and improves hemodynamics in a placebo-controlled study involving stable patients with subarachnoid hemorrhage. AU - Bentsen,Gunnar, AU - Breivik,Harald, AU - Lundar,Tryggve, AU - Stubhaug,Audun, PY - 2006/11/1/pubmed PY - 2006/12/27/medline PY - 2006/11/1/entrez SP - 2912 EP - 7 JF - Critical care medicine JO - Crit. Care Med. VL - 34 IS - 12 N2 - OBJECTIVE: To compare the effects of a bolus infusion of hypertonic saline hydroxyethyl starch with the effects of normal saline (placebo) on intracranial pressure (ICP) and cerebral perfusion pressure in patients with spontaneous subarachnoid hemorrhage. DESIGN AND SETTING: Prospective, randomized, single-blinded, placebo-controlled study in a university hospital. PATIENTS: A total of 22 mechanically ventilated patients with spontaneous subarachnoid hemorrhage with stable ICP between 10 and 20 mm Hg. INTERVENTIONS: During the course of 30 mins, 2 mL/kg of either 7.2% saline in 6% hydroxyethyl starch 200/0.5 (HSS) or of normal saline was infused. The effects were observed for another 180 mins. MEASUREMENTS AND MAIN RESULTS: Mean change in ICP after intervention (DeltaICP) calculated from the average of all observations was -3.3 (sd 2.6) mm Hg in the HSS group vs. -0.3 (sd 1.3) mm Hg in the normal saline group. Mean difference between the groups (HSS - normal saline) was -3.0 mm Hg (95% confidence interval, -4.9 to -1.1; p = .004). Mean peak change after HSS was -5.6 (range, -0.8 to -12.2) mm Hg after 64 (range, 40 to 115) mins. Mean difference in cerebral perfusion pressure change between the groups (HSS - normal saline) was 5.4 mm Hg (95% confidence interval, 2.2 to 8.6; p = .002), and mean difference in cardiac index change, measured as the area under the curve for the whole study period, corresponded to 0.2 L.min.m (95% confidence interval, 0.03 to 0.4; p = .025). CONCLUSIONS: In this placebo-controlled study involving spontaneous subarachnoid hemorrhage patients with normal to moderately increased ICP, 2 mL/kg HSS reduced ICP and increased cerebral perfusion pressure significantly. Maximum effect was reached at twice the infusion time of 30 mins. There were also beneficial hemodynamic effects with increased cardiac index in the HSS group. SN - 0090-3493 UR - https://www.unboundmedicine.com/medline/citation/17075367/Hypertonic_saline__7_2__in_6_hydroxyethyl_starch_reduces_intracranial_pressure_and_improves_hemodynamics_in_a_placebo_controlled_study_involving_stable_patients_with_subarachnoid_hemorrhage_ L2 - https://dx.doi.org/10.1097/01.CCM.0000245665.46789.7C DB - PRIME DP - Unbound Medicine ER -