title: Hypertonic saline for the treatment of intracranial hypertension.
abstract: Intracranial hypertension is caused by brain edema generated by different disorders, the commonest of which is traumatic brain injury. The treatment of brain edema focuses on drawing water out of brain tissue into the intravascular space. This is typically accomplished with osmolar therapy, most commonly mannitol and hypertonic saline. Recent human trials suggest that hypertonic saline may have a more profound and long-lasting effect in reducing intracranial hypertension following traumatic brain injury when compared with mannitol. However, reports suffer from inconsistencies in dose, frequency, concentration, and route of administration. Side effect profile, potential complications, and contraindications to administration need to be factored in when considering which first-line osmotherapy to choose for a given patient with head injury.
authors.affiliation: Division of Traumatology, Surgical Critical Care & Emergency Surgery, University of Pennsylvania School of Medicine, Department of Surgery, Philadelphia, PA, USA, Tareq.Kheirbek@uphs.upenn.edu.
authors.forename: Tareq
authors.initials: T
authors.lastname: Kheirbek
authors.forename: Jose L
authors.initials: JL
authors.lastname: Pascual
mesh_terms: D000959:Antihypertensive Agents / Q000627:therapeutic use*; D006801:Humans; D019586:Intracranial Hypertension / Q000188:drug therapy*; D012462:Saline Solution, Hypertonic / Q000627:therapeutic use*
chemical_list: D000959:Antihypertensive Agents; D012462:Saline Solution, Hypertonic
references.citation: J Neurotrauma. 2007;24 Suppl 1:S14-20
references.pmid: 17511539
references.citation: Crit Care Med. 2005 Oct;33(10):2207-13
references.pmid: 16215372
references.citation: J Neurosurg. 2012 Jan;116(1):210-21
references.pmid: 21942722
references.citation: J Neurol Neurosurg Psychiatry. 2009 Aug;80(8):916-20
references.pmid: 19293171
references.citation: Crit Care Med. 2002 Aug;30(8):1870-6
references.pmid: 12163808
references.citation: Am Surg. 2008 Mar;74(3):253-9
references.pmid: 18376694
references.citation: J Head Trauma Rehabil. 2006 Sep-Oct;21(5):375-8
references.pmid: 16983222
references.citation: Annu Rev Med. 1993;44:289-301
references.pmid: 8476251
references.citation: Crit Care. 2011;15(5):R260
references.pmid: 22035596
references.citation: Crit Care Med. 2006 Dec;34(12):2912-7
references.pmid: 17075367
references.citation: Intensive Care Med. 2009 Mar;35(3):471-9
references.pmid: 18807008
references.citation: J Trauma. 2003 Jan;54(1):121-30; discussion 130-2
references.pmid: 12544907
references.citation: Crit Care Med. 2003 Jun;31(6):1683-7
references.pmid: 12794404
references.citation: Natl Vital Stat Rep. 2013 Dec 20;62(6):1-96
references.pmid: 24364902
references.citation: J Trauma Acute Care Surg. 2012 Aug;73(2):351-7; discussion 357
references.pmid: 22846939
references.citation: Ir J Med Sci. 2015 Mar;184(1):159-65
references.pmid: 24532091
references.citation: J Neurosurg. 1977 Oct;47(4):503-16
references.pmid: 903804
references.citation: Anesthesiology. 1998 Jun;88(6):1586-91
references.pmid: 9637653
references.citation: Cerebrovasc Dis. 2011;31(6):521-31
references.pmid: 21487216
references.citation: Neurosurg Focus. 2007 May 15;22(5):E1
references.pmid: 17613227
references.citation: Crit Care Med. 2009 Apr;37(4):1433-41
references.pmid: 19242317
references.citation: Br J Neurosurg. 1999 Dec;13(6):564-9
references.pmid: 10715724
references.citation: Ann Surg. 2002 Nov;236(5):634-42
references.pmid: 12409670
references.citation: J Trauma. 1999 Oct;47(4):659-65
references.pmid: 10528599
references.citation: J Lab Clin Med. 1991 Jan;117(1):60-6
references.pmid: 1987310
references.citation: J Neuroinflammation. 2010 Jan 18;7:5
references.pmid: 20082712
references.citation: Arch Phys Med Rehabil. 2014 Mar;95(3 Suppl):S230-7
references.pmid: 24581908
references.citation: N Engl J Med. 2012 Dec 27;367(26):2471-81
references.pmid: 23234472
references.citation: Stroke. 2002 Jan;33(1):136-40
references.pmid: 11779902
references.citation: Crit Care Med. 2011 Jul;39(7):1766-72
references.pmid: 21494103
references.citation: Eur J Anaesthesiol Suppl. 2008;42:104-9
references.pmid: 18289426
references.citation: Crit Care Med. 2005 Jan;33(1):196-202; discussion 257-8
references.pmid: 15644669
references.citation: Crit Care. 2005 Oct 5;9(5):R530-40
references.pmid: 16277715
references.citation: Crit Care Med. 2011 Mar;39(3):554-9
references.pmid: 21242790
references.citation: Neurocrit Care. 2011 Apr;14(2):222-8
references.pmid: 21153930
references.citation: Neurol Res. 2005 Apr;27(3):280-6
references.pmid: 15845211
references.citation: Scand J Clin Lab Invest. 2005;65(1):13-22
references.pmid: 15859023
references.citation: Stroke. 2011 Jun;42(6):1540-5
references.pmid: 21512173
references.citation: N Engl J Med. 2011 Apr 21;364(16):1493-502
references.pmid: 21434843
references.citation: Crit Care Med. 1998 Jul;26(7):1265-70
references.pmid: 9671379
references.citation: Crit Care Med. 1998 Mar;26(3):440-6
references.pmid: 9504569
references.citation: Crit Care Med. 2008 Mar;36(3):795-800
references.pmid: 18209674