title: Hypertonic saline for treating raised intracranial pressure: literature review with meta-analysis.
abstract: OBJECTIVE
  Currently, mannitol is the recommended first choice for a hyperosmolar agent for use in patients with elevated intracranial pressure (ICP). Some authors have argued that hypertonic saline (HTS) might be a more effective agent; however, there is no consensus as to appropriate indications for use, the best concentration, and the best method of delivery. To answer these questions better, the authors performed a review of the literature regarding the use of HTS for ICP reduction.
  
  
  METHODS
  A PubMed search was performed to locate all papers pertaining to HTS use. This search was then narrowed to locate only those clinical studies relating to the use of HTS for ICP reduction.
  
  
  RESULTS
  A total of 36 articles were selected for review. Ten were prospective randomized controlled trials (RCTs), 1 was prospective and nonrandomized, 15 were prospective observational trials, and 10 were retrospective trials. The authors did not distinguish between retrospective observational studies and retrospective comparison trials. Prospective studies were considered observational if the effects of a treatment were evaluated over time but not compared with another treatment.
  
  
  CONCLUSIONS
  The available data are limited by low patient numbers, limited RCTs, and inconsistent methods between studies. However, a greater part of the data suggest that HTS given as either a bolus or continuous infusion can be more effective than mannitol in reducing episodes of elevated ICP. A meta-analysis of 8 prospective RCTs showed a higher rate of treatment failure or insufficiency with mannitol or normal saline versus HTS.
authors.affiliation: Division of Neurological Surgery, University of Alabama at Birmingham, Alabama, USA.
authors.forename: Martin M
authors.initials: MM
authors.lastname: Mortazavi
authors.forename: Andrew K
authors.initials: AK
authors.lastname: Romeo
authors.forename: Aman
authors.initials: A
authors.lastname: Deep
authors.forename: Christoph J
authors.initials: CJ
authors.lastname: Griessenauer
authors.forename: Mohammadali M
authors.initials: MM
authors.lastname: Shoja
authors.forename: R Shane
authors.initials: RS
authors.lastname: Tubbs
authors.forename: Winfield
authors.initials: W
authors.lastname: Fisher
mesh_terms: D006801:Humans; D019586:Intracranial Hypertension / Q000188:drug therapy*; D007427:Intracranial Pressure / Q000187:drug effects*; D016032:Randomized Controlled Trials as Topic; D012462:Saline Solution, Hypertonic / Q000494:pharmacology / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D012462:Saline Solution, Hypertonic