title: Use of hypertonic (3%) saline/acetate infusion in the treatment of cerebral edema: Effect on intracranial pressure and lateral displacement of the brain.
abstract: OBJECTIVE
  To determine the effect of continuous hypertonic (3%) saline/acetate infusion on intracranial pressure (ICP) and lateral displacement of the brain in patients with cerebral edema.
  
  
  METHODS
  Retrospective chart review.
  
  
  METHODS
  Neurocritical care unit of a university hospital.
  
  
  METHODS
  Twenty-seven consecutive patients with cerebral edema (30 episodes), including patients with head trauma (n = 8), postoperative edema (n = 5), nontraumatic intracranial hemorrhage (n = 8), and cerebral infarction (n = 6).
  
  
  METHODS
  Intravenous infusion of 3% saline/acetate to increase serum sodium concentrations to 145 to 155 mmol/L.
  
  
  RESULTS
  A reduction in mean ICP within the first 12 hrs correlating with an increase in the serum sodium concentration was observed in patients with head trauma (r2 = .91, p = .03), and postoperative edema (r2 = .82, p = .06), but not in patients with nontraumatic intracranial hemorrhage or cerebral infarction. In patients with head trauma, the beneficial effect of hypertonic saline on ICP was short-lasting, and after 72 hrs of infusion, four patients required intravenous pentobarbital due to poor ICP control. Among the 21 patients who had a repeat computed tomographic scan within 72 hrs of initiating hypertonic saline, lateral displacement of the brain was reduced in patients with head trauma (2.8 +/- 1.4 to 1.1 +/- 0.9 [SEM]) and in patients with postoperative edema (3.1 +/- 1.6 to 1.1 +/- 0.7). This effect was not observed in patients with nontraumatic intracranial bleeding or cerebral infarction. The treatment was terminated in three patients due to the development of pulmonary edema, and was terminated in another three patients due to development of diabetes insipidus.
  
  
  CONCLUSIONS
  Hypertonic saline administration as a 3% infusion appears to be a promising therapy for cerebral edema in patients with head trauma or postoperative edema. Further studies are required to determine the optimal duration of benefit and the specific patient population that is most likely to benefit from this treatment.
authors.affiliation: Division of Neurosciences Critical Care, The Johns Hopkins Medical Institutions, Baltimore, MD, USA.
authors.forename: A I
authors.initials: AI
authors.lastname: Qureshi
authors.forename: J I
authors.initials: JI
authors.lastname: Suarez
authors.forename: A
authors.initials: A
authors.lastname: Bhardwaj
authors.forename: M
authors.initials: M
authors.lastname: Mirski
authors.forename: M S
authors.initials: MS
authors.lastname: Schnitzer
authors.forename: D F
authors.initials: DF
authors.lastname: Hanley
authors.forename: J A
authors.initials: JA
authors.lastname: Ulatowski
mesh_terms: D000328:Adult; D001921:Brain / Q000000981:diagnostic imaging*; D001929:Brain Edema / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D001930:Brain Injuries / Q000150:complications; D002543:Cerebral Hemorrhage / Q000150:complications; D006801:Humans; D007427:Intracranial Pressure; D008875:Middle Aged; D011183:Postoperative Complications; D012189:Retrospective Studies; D012462:Saline Solution, Hypertonic / Q000009:adverse effects / Q000627:therapeutic use*; D019346:Sodium Acetate / Q000008:administration & dosage; D014057:Tomography, X-Ray Computed
chemical_list: D012462:Saline Solution, Hypertonic; D019346:Sodium Acetate