title: Three-percent saline administration during pediatric critical care transport.
abstract: OBJECTIVE
  The purpose of this study was to describe the administration of 3% saline (3%S) during pediatric critical care transport.
  
  
  METHODS
  A retrospective study was performed on pediatric patients who underwent critical transport to Loma Linda University Children's Hospital from January 1, 2003, to June 30, 2007, and were given 3%S. Patients' demographics, admission diagnosis, route and amount of 3%S administration, serum electrolytes, vital signs, radiographic data, and Glasgow Coma Scale scores were collected and analyzed.
  
  
  RESULTS
  A total of 101 children who received 3%S infusions during pediatric critical care transport were identified. Mean patient age was 5.9 years, and mean patient weight was 27.6 kg. The main indications for infusing 3%S were suspected cerebral edema (41%), intracranial bleed with edema (51%), and symptomatic hyponatremia (6%). The amount of 3%S bolus ranged from 1.2 to 24 mL/kg, with a mean of 5.4 mL/kg. Serum electrolytes before and after 3%S infusion demonstrated significant increases in sodium, chloride, and bicarbonate levels (P < 0.05). A significant reduction was also seen in serum urea nitrogen levels and anion gap. Radiographic imaging performed before 3%S infusion demonstrated findings consistent with concerns of increased intracranial pressure such as intracranial bleed and cerebral edema. The route of initial 3%S infusions was mainly through peripheral intravenous lines (96%). No complications related to the 3%S delivery such as local reactions, renal abnormalities, or central pontine myelinolysis were observed.
  
  
  CONCLUSIONS
  It seems 3%S may be administered safely during pediatric critical transport and administration routes can include peripheral lines. With the importance of initiating therapy early to improve patient outcomes, the use of 3%S may benefit transported children with brain injury and suspected intracranial hypertension.
authors: Department of Pediatrics, Loma Linda University Children's Hospital, Loma Linda, CA 92354, USA.
authors: Johnny L
authors: JL
authors: Luu
authors: Cherry L
authors: CL
authors: Wendtland
authors: Matthew F
authors: MF
authors: Gross
authors: Farrukh
authors: F
authors: Mirza
authors: Alexander
authors: A
authors: Zouros
authors: Grenith J
authors: GJ
authors: Zimmerman
authors: Besh
authors: B
authors: Barcega
authors: Shamel A
authors: SA
authors: Abd-Allah
mesh_terms: D000293:Adolescent; D000552:Ambulances / Q000706:statistics & numerical data; D001929:Brain Edema / Q000188:drug therapy / Q000209:etiology / Q000517:prevention & control; D001930:Brain Injuries / Q000097:blood / Q000150:complications / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000628:therapy; D002405:Catheterization, Central Venous; D002406:Catheterization, Peripheral; D002648:Child; D002675:Child, Preschool; D003422:Critical Care / Q000379:methods*; D004305:Dose-Response Relationship, Drug; D004341:Drug Evaluation; D004359:Drug Therapy, Combination; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D007223:Infant; D017148:Infusions, Intraosseous; D015278:Intensive Care Units, Pediatric; D019586:Intracranial Hypertension / Q000188:drug therapy / Q000209:etiology / Q000517:prevention & control; D008297:Male; D008353:Mannitol / Q000008:administration & dosage / Q000627:therapeutic use; D011859:Radiography; D012121:Respiration, Artificial; D012189:Retrospective Studies; D012462:Saline Solution, Hypertonic / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D012964:Sodium / Q000097:blood; D014187:Transportation of Patients
chemical_list: D012462:Saline Solution, Hypertonic; D008353:Mannitol; D012964:Sodium