Hypertonic saline solutions for treatment of intracranial hypertension.
OBJECTIVE
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.


RESULTS
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.


CONCLUSIONS
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.
Himmelseher
Sabine
S
Department of Anaesthesiology, Klinikum rechts der Isar, Ismanigerstrasse 22, D-81675 Munich, Germany. s.himmelseher@gmx.de
D000818:Animals; D001930:Brain Injuries / Q000150:complications*; D002560:Cerebrovascular Circulation / Q000187:drug effects*; D004234:Diuretics, Osmotic / Q000627:therapeutic use; D016903:Drug Monitoring / Q000379:methods; D006801:Humans; D006895:Hydroxyethyl Starch Derivatives / Q000627:therapeutic use; D007262:Infusions, Intravenous; D019586:Intracranial Hypertension / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology; D008353:Mannitol / Q000627:therapeutic use; D009994:Osmolar Concentration; D010952:Plasma Substitutes / Q000627:therapeutic use; D012016:Reference Values; D012462:Saline Solution, Hypertonic / Q000627:therapeutic use*; D012964:Sodium / Q000097:blood; D016896:Treatment Outcome
D004234:Diuretics, Osmotic; D006895:Hydroxyethyl Starch Derivatives; D010952:Plasma Substitutes; D012462:Saline Solution, Hypertonic; D008353:Mannitol; D012964:Sodium