Hypertonic saline in paediatric traumatic brain injury: a review of nine years' experience with 23.4% hypertonic saline as standard hyperosmolar therapy.
We describe the protocolised use of 23.4% hypertonic saline solution (HTS) for intracranial hypertension in the context of traumatic brain injury in the paediatric population. This study represents the largest published data on the use of 23.4% HTS in the paediatric population. In this retrospective cohort, we focus on the efficacy, biochemical and metabolic consequences of 23.4% HTS administration in a Level 1 paediatric trauma centre. Mortality in the first seven days was 6% (2/32) with a mean intensive care unit length-of-stay of ten days (range 2 to 25, standard deviation [SD] 6). All-cause hospital mortality was 6%, with no deaths after the seven-day study period. Mean intracranial pressure (ICP) response to HTS was 10 mmHg (range 1 to 30, SD 8). For biochemistry data, the mean highest daily serum sodium was 148 mmol/l (139 to 161, SD 6), mean highest serum chloride was 115 mmol/l (range 101 to 132, SD 8) with matched mean serum base excess of -1.5 mmol/l (range 2 to -8, SD 3) and mean peak serum creatinine was 73 mmol/l (range 32 to 104, SD 32). Glasgow outcome scores of >3 (independent function) were achieved in 74% of patients. We describe the use of 23.4% HTS, demonstrating it to be a practical and efficacious method of delivering osmoles and may be advantageous in minimising total fluid volume. Thus, the bolus versus infusion debate may best be served via combining both approaches.
Department of Anaesthesia and Intensive Care, John Hunter Hospital, Newcastle, New South Wales.
B J
BJ
Piper
Department of Anaesthesia and Intensive Care, John Hunter Hospital, Newcastle, Australia.
P W
PW
Harrigan
D000293:Adolescent; D001930:Brain Injuries / Q000097:blood / Q000150:complications*; D002648:Child; D015331:Cohort Studies; D003404:Creatinine / Q000097:blood; D005260:Female; D005440:Fluid Therapy / Q000379:methods; D015600:Glasgow Coma Scale; D017052:Hospital Mortality; D006801:Humans; D007223:Infant; D019586:Intracranial Hypertension / Q000097:blood / Q000188:drug therapy* / Q000209:etiology*; D007427:Intracranial Pressure / Q000187:drug effects; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D010372:Pediatrics / Q000379:methods; D012189:Retrospective Studies; D012462:Saline Solution, Hypertonic / Q000627:therapeutic use*; D012964:Sodium / Q000097:blood; D016896:Treatment Outcome
D012462:Saline Solution, Hypertonic; D012964:Sodium; D003404:Creatinine
brain injury; hyperosmolar therapy; hypertonic; intracranial hypertension; paediatric; saline solution