Use of hypertonic saline injection in trauma.
OBJECTIVE
The use of hypertonic saline injection in trauma patients is discussed.


CONCLUSIONS
Patients with hemorrhage, burns, and traumatic brain injury (TBI) may develop hypovolemic shock and require resuscitation. Compared with conventional isotonic crystalloids, hypertonic saline has several advantages, including hemodynamic, immune-modulating, and antiinflammatory effects, for use in trauma patients for resuscitation. In addition, hypertonic saline is also used in patients with TBI to reduce intracranial pressure (ICP). Overall, studies have not shown a difference in mortality or other clinically important outcomes with the use of hypertonic saline for resuscitation in trauma patients; however, most of these studies were not adequately powered to show significant differences. A recent Cochrane review concluded that there is no evidence that hypertonic crystalloids are better than isotonic or near-isotonic crystalloids for fluid resuscitation in trauma patients. Two recent trials that were adequately powered to investigate a mortality endpoint were halted for futility. A few small randomized controlled studies found that hypertonic saline was more effective than mannitol as a hyperosmolar agent for ICP reduction. Recent guidelines from the American Burn Association have suggested that hypertonic saline may be used for burn shock resuscitation by experienced providers with close monitoring to avoid excessive hypernatremia. One of the main concerns with the use of hypertonic saline is its potential to cause central pontine myelinolysis due to a rapid increase in serum sodium levels.


CONCLUSIONS
There is no evidence that hypertonic saline provides any additional benefit over isotonic crystalloid solutions for trauma resuscitation. Hypertonic saline may be more effective than mannitol at reducing ICP in patients with TBI.
Department of Pharmacy Practice and Science, College of Pharmacy, University of Arizona, 1295 North Martin, P.O. Box 210202, Tucson, AZ 85721-0207, USA. patanwala@pharmacy.arizona.edu
Asad E
AE
Patanwala
Albert
A
Amini
Brian L
BL
Erstad
D000818:Animals; D001930:Brain Injuries / Q000150:complications / Q000503:physiopathology / Q000628:therapy*; D002056:Burns / Q000150:complications; D000077324:Crystalloid Solutions; D006470:Hemorrhage / Q000150:complications / Q000628:therapy; D006801:Humans; D007552:Isotonic Solutions / Q000627:therapeutic use; D008353:Mannitol / Q000627:therapeutic use; D017410:Practice Guidelines as Topic; D012462:Saline Solution, Hypertonic / Q000009:adverse effects / Q000627:therapeutic use*; D012769:Shock / Q000209:etiology / Q000628:therapy*
D000077324:Crystalloid Solutions; D007552:Isotonic Solutions; D012462:Saline Solution, Hypertonic; D008353:Mannitol