title: Hypertonic saline infusion in traumatic brain injury increases the incidence of pulmonary infection.
abstract: We aimed to investigate the incidence of electrolyte abnormalities, acute kidney injury (AKI), deep venous thrombosis (DVT) and infections in patients with traumatic brain injury (TBI) treated with hypertonic saline (HTS) as osmolar therapy. We retrospectively studied 205 TBI patients, 96 with HTS and 109 without, admitted to the surgical/trauma intensive care unit between 2006 and 2012. Hemodynamics, electrolytes, length of stay (LOS), acute physiological assessment and chronic health evaluation II (APACHE II), injury severity scores (ISS) and mortality were tabulated. Infection, mechanical ventilation, DVT and AKI incidence were reviewed. HTS was associated with increased LOS and all infections (p=0.0001). After correction for the Glasgow coma scale (GCS) and ventilator need, pulmonary infections (p=0.001) and LOS remained higher with HTS (p=0.0048). HTS did not result in increased blood pressure, DVT, AKI or neurological benefits. HTS significantly increased the odds for all infections, most specifically pulmonary infections, in patients with GCS<8. Due to these findings, HTS in TBI should be administered with caution regardless of acuity.
authors.affiliation: Department of Surgery, Surgical/Trauma Intensive Care Unit, Elmhurst Hospital Center, Mount Sinai School of Medicine, 79-01 Broadway, Elmhurst, NY 11373, USA; Department of Medicine, Division of Nephrology, Elmhurst Hospital Center, Mount Sinai School of Medicine, Elmhurst, NY, USA. Electronic address: coritsg@nychhc.org.
authors.forename: George
authors.initials: G
authors.lastname: Coritsidis
authors.affiliation: Department of Surgery, Surgical/Trauma Intensive Care Unit, Elmhurst Hospital Center, Mount Sinai School of Medicine, 79-01 Broadway, Elmhurst, NY 11373, USA.
authors.forename: Nechama
authors.initials: N
authors.lastname: Diamond
authors.affiliation: Department of Surgery, Surgical/Trauma Intensive Care Unit, Elmhurst Hospital Center, Mount Sinai School of Medicine, 79-01 Broadway, Elmhurst, NY 11373, USA.
authors.forename: Aleef
authors.initials: A
authors.lastname: Rahman
authors.affiliation: Department of Radiology, Elmhurst Hospital Center, Elmhurst, NY, USA.
authors.forename: Paul
authors.initials: P
authors.lastname: Solodnik
authors.affiliation: Department of Medicine, Division of Nephrology, Elmhurst Hospital Center, Mount Sinai School of Medicine, Elmhurst, NY, USA.
authors.forename: Kayode
authors.initials: K
authors.lastname: Lawrence
authors.affiliation: Department of Medicine, Elmhurst Hospital Center, Elmhurst, NY, USA.
authors.forename: Salwa
authors.initials: S
authors.lastname: Rhazouani
authors.affiliation: Department of Surgery, Surgical/Trauma Intensive Care Unit, Elmhurst Hospital Center, Mount Sinai School of Medicine, 79-01 Broadway, Elmhurst, NY 11373, USA.
authors.forename: Suganda
authors.initials: S
authors.lastname: Phalakornkul
mesh_terms: D058186:Acute Kidney Injury / Q000453:epidemiology / Q000209:etiology; D000328:Adult; D000368:Aged; D001930:Brain Injuries / Q000150:complications / Q000188:drug therapy*; D005260:Female; D006801:Humans; D015994:Incidence; D007362:Intensive Care Units / Q000706:statistics & numerical data; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D012141:Respiratory Tract Infections / Q000453:epidemiology* / Q000209:etiology; D012189:Retrospective Studies; D012462:Saline Solution, Hypertonic / Q000009:adverse effects*
chemical_list: D012462:Saline Solution, Hypertonic
keywords: Hypertonic saline; Infection; Neurocritical care; Pneumonia; Traumatic brain injury