Prolonged hypernatremia controls elevated intracranial pressure in head-injured pediatric patients.
OBJECTIVE
To determine the effects continuous infusions of hypertonic saline (3% NaCl) on intracranial pressure (ICP) control and describe the physiologic effects of hypertonic saline administered to closed head injury children.


METHODS
Retrospective chart review.


METHODS
Pediatric intensive care unit of a children's hospital.


METHODS
Sixty-eight children with closed head injury.


METHODS
Intravenous infusion of 3% hypertonic saline to increase serum sodium to levels necessary to reduce ICP < or =20 mm Hg.


RESULTS
The patients enrolled had similar Injury Severity Scores. Treatment effectively lowered ICP in these patients and ICP was under good control a majority of the time. Only three patients (4%) died of uncontrolled elevation of ICP. No adverse effects of supraphysiologic hyperosmolarity such as renal failure, pulmonary edema, or central pontine demyelination, were noted.


CONCLUSIONS
Hypertonic saline administration to children with closed head injury appears to be a promising therapy for control of cerebral edema. Further controlled trials are required to determine the optimal duration of treatment before widespread use is advocated.
Peterson
B
B
Department of Critical Care and Anesthesia, San Diego Children's Hospital, CA 92123, USA.
Khanna
S
S
Fisher
B
B
Marshall
L
L
D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D006259:Craniocerebral Trauma / Q000097:blood / Q000188:drug therapy / Q000401:mortality / Q000503:physiopathology*; D004232:Diuretics / Q000008:administration & dosage; D004234:Diuretics, Osmotic / Q000008:administration & dosage; D004359:Drug Therapy, Combination; D005260:Female; D005665:Furosemide / Q000008:administration & dosage; D015600:Glasgow Coma Scale; D006801:Humans; D006955:Hypernatremia / Q000097:blood / Q000139:chemically induced / Q000503:physiopathology*; D006982:Hypertonic Solutions / Q000008:administration & dosage; D007262:Infusions, Intravenous; D007427:Intracranial Pressure / Q000187:drug effects*; D008297:Male; D008353:Mannitol / Q000008:administration & dosage; D012189:Retrospective Studies; D016019:Survival Analysis
D004232:Diuretics; D004234:Diuretics, Osmotic; D006982:Hypertonic Solutions; D008353:Mannitol; D005665:Furosemide