Continuous controlled-infusion of hypertonic saline solution in traumatic brain-injured patients: a 9-year retrospective study.
BACKGROUND
Description of a continuous hypertonic saline solution (HSS) infusion using a dose-adaptation of natremia in traumatic brain injured (TBI) patients with refractory intracranial hypertension (ICH).


METHODS
We performed a single-center retrospective study in a surgical intensive care unit of a tertiary hospital. Fifty consecutive TBI patients with refractory ICH treated with continuous HSS infusion adapted to a target of natremia. In brief, a physician set a target of natremia adapted to the evolution of intracranial pressure (ICP). Flow of NaCl 20% was a priori calculated according to natriuresis, and the current and target natremia that were assessed every 4 hours.


RESULTS
The HSS infusion was initiated for a duration of 7 (5 to 10) (8 ± 4) days. ICP decreased from 29 (26 to 34) (31 ± 9) mm Hg at H0 to 20 (15 to 26) (21 ± 8) mm Hg at H1 (P < 0.05). Cerebral perfusion pressure increased from 61 (50 to 70) (61 ± 13) mm Hg at H0 up to 67 (60 to 79) (69 ± 12) mm Hg at H1 (P < 0.05). No rebound of ICH was reported after stopping continuous HSS infusion. Natremia increased from 140 (138 to 143) (140 ± 4) at H0 up to 144 (141 to 148) (144 ± 4) mmol/L at H4 (P < 0.05). Plasma osmolarity increased from 275 (268 to 281) (279 ± 17) mmol/L at H0 up to 290 (284 to 307) (297 ± 17) mmol/L at H24 (P < 0.05). The main side effect observed was an increase in chloremia from 111 (107 to 119) (113 ± 8) mmol/L at H0 up to 121 (117 to 124) (121 ± 6) mmol/L at H24 (P < 0.05). Neither acute kidney injury nor pontine myelinolysis was recorded.


CONCLUSIONS
Continuous HSS infusion adapted to close biologic monitoring enables long-lasting control of natremia in TBI patients along with a decreased ICP without any rebound on infusion discontinuation.
Anesthesiology and Intensive Care Unit, Hôtel Dieu Nantes University Hospital, 1 place Alexis Ricordeau, Nantes, F-44093 France.
Antoine
A
Roquilly
Pierre Joachim
PJ
Mahe
Dominique Demeure Dit
DD
Latte
Olivier
O
Loutrel
Philippe
P
Champin
Christelle
C
Di Falco
Athanase
A
Courbe
Kevin
K
Buffenoir
Olivier
O
Hamel
Corinne
C
Lejus
Véronique
V
Sebille
Karim
K
Asehnoune
D000328:Adult; D001930:Brain Injuries / Q000097:blood / Q000503:physiopathology / Q000628:therapy*; D004305:Dose-Response Relationship, Drug; D005260:Female; D005440:Fluid Therapy / Q000379:methods*; D006801:Humans; D007262:Infusions, Intravenous / Q000379:methods; D019586:Intracranial Hypertension / Q000097:blood / Q000150:complications*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012462:Saline Solution, Hypertonic / Q000008:administration & dosage*; D012964:Sodium / Q000097:blood*; D016896:Treatment Outcome
D012462:Saline Solution, Hypertonic; D012964:Sodium