title: Hypertonic saline in severe traumatic brain injury: a systematic review and meta-analysis of randomized controlled trials.
abstract: OBJECTIVE
  Hypertonic saline solutions are increasingly used to treat increased intracranial pressure following severe traumatic brain injury. However, whether hypertonic saline provides superior management of intracranial pressure and improves outcome is unclear. We thus conducted a systematic review to evaluate the effect of hypertonic saline in patients with severe traumatic brain injury.
  
  
  METHODS
  Two researchers independently selected randomized controlled trials studying hypertonic saline in severe traumatic brain injury and collected data using a standardized abstraction form. No language restriction was applied. We searched MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Scopus, Web of Science, and BIOSIS databases. We searched grey literature via OpenGrey and National Technical Information Service databases. We searched the references of included studies and relevant reviews for additional studies.
  
  
  RESULTS
  Eleven studies (1,820 patients) were included. Hypertonic saline did not decrease mortality (risk ratio 0.96, 95% confidence interval [CI] 0.83 to 1.11, I2=0%) or improve intracranial pressure control (weighted mean difference -1.25 mm Hg, 95% CI -4.18 to 1.68, I2=78%) as compared to any other solutions. Only one study reported monitoring for adverse events with hypertonic saline, finding no significant differences between comparison groups.
  
  
  CONCLUSIONS
  We observed no mortality benefit or effect on the control of intracranial pressure with the use of hypertonic saline when compared to other solutions. Based on the current level of evidence pertaining to mortality or control of intracranial pressure, hypertonic saline could thus not be recommended as a first-line agent for managing patients with severe traumatic brain injury.
authors.affiliation: *Centre de Recherche du CHU de Québec - Université Laval (Hôpital de l'Enfant-Jésus),Population Health and Optimal Health Practices Unit(Trauma - Emergency - Critical Care Medicine) (Axe Santé des populations et pratiques optimales en santé [Traumatologie - Urgence - Soins Intensifs]),Québec,QC.
authors.forename: Elyse
authors.initials: E
authors.lastname: Berger-Pelleiter
authors.affiliation: *Centre de Recherche du CHU de Québec - Université Laval (Hôpital de l'Enfant-Jésus),Population Health and Optimal Health Practices Unit(Trauma - Emergency - Critical Care Medicine) (Axe Santé des populations et pratiques optimales en santé [Traumatologie - Urgence - Soins Intensifs]),Québec,QC.
authors.forename: Marcel
authors.initials: M
authors.lastname: Émond
authors.affiliation: *Centre de Recherche du CHU de Québec - Université Laval (Hôpital de l'Enfant-Jésus),Population Health and Optimal Health Practices Unit(Trauma - Emergency - Critical Care Medicine) (Axe Santé des populations et pratiques optimales en santé [Traumatologie - Urgence - Soins Intensifs]),Québec,QC.
authors.forename: François
authors.initials: F
authors.lastname: Lauzier
authors.affiliation: †Department of Family and Emergency Medicine,Université Laval,Québec,QC.
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Shields
authors.affiliation: *Centre de Recherche du CHU de Québec - Université Laval (Hôpital de l'Enfant-Jésus),Population Health and Optimal Health Practices Unit(Trauma - Emergency - Critical Care Medicine) (Axe Santé des populations et pratiques optimales en santé [Traumatologie - Urgence - Soins Intensifs]),Québec,QC.
authors.forename: Alexis F
authors.initials: AF
authors.lastname: Turgeon
mesh_terms: D000070642:Brain Injuries, Traumatic / Q000175:diagnosis / Q000188:drug therapy / Q000503:physiopathology; D006801:Humans; D007427:Intracranial Pressure / Q000187:drug effects* / Q000502:physiology; D016032:Randomized Controlled Trials as Topic / Q000379:methods*; D012462:Saline Solution, Hypertonic / Q000008:administration & dosage*; D015599:Trauma Severity Indices
chemical_list: D012462:Saline Solution, Hypertonic
keywords: hypertonic saline; meta-analysis; outcome; traumatic brain injury