Effects of 23.4% sodium chloride solution in reducing intracranial pressure in patients with traumatic brain injury: a preliminary study.
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.


CONCLUSIONS
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.
Ware
Marcus L
ML
Department of Neurological Surgery, University of California, San Francisco, California 94110, USA.
Nemani
Venu M
VM
Meeker
Michele
M
Lee
Currie
C
Morabito
Diane J
DJ
Manley
Geoffrey T
GT
D000328:Adult; D000368:Aged; D001930:Brain Injuries / Q000150:complications / Q000188:drug therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D019586:Intracranial Hypertension / Q000188:drug therapy / Q000209:etiology / Q000517:prevention & control*; D007427:Intracranial Pressure / Q000187:drug effects / Q000502:physiology; D008297:Male; D008353:Mannitol / Q000494:pharmacology / Q000627:therapeutic use; D008875:Middle Aged; D016032:Randomized Controlled Trials as Topic; D012189:Retrospective Studies; D012462:Saline Solution, Hypertonic / Q000494:pharmacology / Q000627:therapeutic use*
D012462:Saline Solution, Hypertonic; D008353:Mannitol