Opposed effects of hypertonic saline on contusions and noncontused brain tissue in patients with severe traumatic brain injury.
OBJECTIVE
The aim of this study was to quantify the effect of hypertonic saline solution on contused and noncontused brain tissue in patients with traumatic brain injury. We hypothesize that hypertonic saline would increase the volume of brain contusion while decreasing the volume of noncontused hemispheric areas.


METHODS
Prospective observational study.


METHODS
Neurosciences critical care unit of a university hospital.


METHODS
Fourteen traumatic brain injury patients with increased intracranial pressure.


METHODS
A computed tomography scan was performed before and after a 20-min infusion of 40 mL of 20% saline.


RESULTS
The volume, weight, and specific gravity of contused and noncontused hemispheric areas were assessed from computed tomography DICOM images by using a custom-designed software (BrainView). Physiologic variables and natremia were measured before and after infusion. Hypertonic saline significantly increased natremia from 143 +/- 5 to 146 +/- 5 mmol/L and decreased intracranial pressure from 23 +/- 3 to 17 +/- 5 mm Hg. The volume of the noncontused hemispheric areas decreased by 13 +/- 8 mL whereas the specific gravity increased by 0.029 +/- 0.027%. The volume of contused hemispheric tissue increased by 5 +/- 5 mL without any con-comitant change in density. There was a wide interindividual variability in the response of the noncontused hemispheric tissue with changes in specific gravity varying between -0.0124% and 0.0998%.


CONCLUSIONS
Three days after traumatic brain injury, the blood- brain barrier remains semipermeable in noncontused areas but not in contusions. Further studies are needed to tailor the use of hypertonic saline in patients with traumatic brain injury according to the volume of contusions assessed on computed tomography.
Lescot
Thomas
T
Department of Anesthesiology and Critical Care, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris; Université Pierre et Marie Curie-Paris 6, France.
Degos
Vincent
V
Zouaoui
Abderrezak
A
Préteux
Françoise
F
Coriat
Pierre
P
Puybasset
Louis
L
D000293:Adolescent; D000328:Adult; D000368:Aged; D001812:Blood-Brain Barrier / Q000000981:diagnostic imaging / Q000187:drug effects / Q000378:metabolism; D001921:Brain / Q000000981:diagnostic imaging / Q000187:drug effects* / Q000473:pathology; D001930:Brain Injuries / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000473:pathology; D005260:Female; D006785:Hospitals, University; D006801:Humans; D007427:Intracranial Pressure / Q000187:drug effects; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012462:Saline Solution, Hypertonic / Q000494:pharmacology* / Q000627:therapeutic use; D012964:Sodium / Q000097:blood; D013046:Specific Gravity; D014057:Tomography, X-Ray Computed
D012462:Saline Solution, Hypertonic; D012964:Sodium