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Hypertonic saline solutions for treatment of intracranial hypertension.
Curr Opin Anaesthesiol. 2007 Oct; 20(5):414-26.CO

Abstract

PURPOSE OF REVIEW

This review aims to provide an update on recent knowledge gained on hypertonic saline solutions for the treatment of intracranial hypertension. Explanatory approaches to the mechanisms underlying the edema-reducing effects of the solutions are outlined, practical aspects of use are presented, and trials that assessed their clinical utility are highlighted.

RECENT FINDINGS

With an established trauma system, hypertonic saline added to conventional fluid resuscitation did not improve long-term outcome in multiple injury with hypotension and brain trauma. In intensive care, hypertonic saline reduced intracranial hypertension after subarachnoid haemorrhage, brain trauma, and a variety of other brain diseases, including cerebral edema in acute liver failure.

SUMMARY

Hypertonic saline solutions have evolved as an alternative to mannitol or may be used in otherwise refractory intracranial hypertension to treat raised intracranial pressure. With high osmolar loads, the efficacy of the solution is enhanced, but no simple relationship between the saline concentration and the clinical effects of a solution is established. Caution is advised with high osmolar loads because they carry increased risks for potentially deleterious consequences of hypernatremia or may induce osmotic blood-brain barrier opening with possibly harmful extravasation of the hypertonic solution into the brain tissue.

Authors+Show Affiliations

Department of Anaesthesiology, Klinikum rechts der Isar, Ismanigerstrasse 22, D-81675 Munich, Germany. s.himmelseher@gmx.de

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

17873594

Citation

Himmelseher, Sabine. "Hypertonic Saline Solutions for Treatment of Intracranial Hypertension." Current Opinion in Anaesthesiology, vol. 20, no. 5, 2007, pp. 414-26.
Himmelseher S. Hypertonic saline solutions for treatment of intracranial hypertension. Curr Opin Anaesthesiol. 2007;20(5):414-26.
Himmelseher, S. (2007). Hypertonic saline solutions for treatment of intracranial hypertension. Current Opinion in Anaesthesiology, 20(5), 414-26.
Himmelseher S. Hypertonic Saline Solutions for Treatment of Intracranial Hypertension. Curr Opin Anaesthesiol. 2007;20(5):414-26. PubMed PMID: 17873594.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Hypertonic saline solutions for treatment of intracranial hypertension. A1 - Himmelseher,Sabine, PY - 2007/9/18/pubmed PY - 2008/3/11/medline PY - 2007/9/18/entrez SP - 414 EP - 26 JF - Current opinion in anaesthesiology JO - Curr Opin Anaesthesiol VL - 20 IS - 5 N2 - PURPOSE OF REVIEW: This review aims to provide an update on recent knowledge gained on hypertonic saline solutions for the treatment of intracranial hypertension. Explanatory approaches to the mechanisms underlying the edema-reducing effects of the solutions are outlined, practical aspects of use are presented, and trials that assessed their clinical utility are highlighted. RECENT FINDINGS: With an established trauma system, hypertonic saline added to conventional fluid resuscitation did not improve long-term outcome in multiple injury with hypotension and brain trauma. In intensive care, hypertonic saline reduced intracranial hypertension after subarachnoid haemorrhage, brain trauma, and a variety of other brain diseases, including cerebral edema in acute liver failure. SUMMARY: Hypertonic saline solutions have evolved as an alternative to mannitol or may be used in otherwise refractory intracranial hypertension to treat raised intracranial pressure. With high osmolar loads, the efficacy of the solution is enhanced, but no simple relationship between the saline concentration and the clinical effects of a solution is established. Caution is advised with high osmolar loads because they carry increased risks for potentially deleterious consequences of hypernatremia or may induce osmotic blood-brain barrier opening with possibly harmful extravasation of the hypertonic solution into the brain tissue. SN - 0952-7907 UR - https://www.unboundmedicine.com/medline/citation/17873594/Hypertonic_saline_solutions_for_treatment_of_intracranial_hypertension_ L2 - http://dx.doi.org/10.1097/ACO.0b013e3282eff9ea DB - PRIME DP - Unbound Medicine ER -