Hypertonic/hyperoncotic saline reliably reduces ICP in severely head-injured patients with intracranial hypertension.

Publication Type	Academic Article
Authors	Härtl R, Ghajar J, Hochleuthner H, Mauritz W
Journal	Acta Neurochir Suppl
Volume	70
Pagination	126-9
Date Published	01/01/1997
ISSN	0065-1419
Keywords	Craniocerebral Trauma, Hydroxyethyl Starch Derivatives, Intracranial Hypertension, Saline Solution, Hypertonic
Abstract	Hypertonic saline (HS) has been shown to decrease intracranial pressure (ICP) and cerebral water content in experimental models of traumatic brain injury (TBI). The purpose of the present study was to test the efficacy of administration of HS (7.5%) combined with 6% hydroxyethyl starch (molecular weight 200.000/0.60-0.66; HHES) for the treatment of therapy-resistant intracranial hypertension in patients with severe TBI. Six patients with severe TBI (GCS < 8) who met the inclusion criteria (therapy resistant ICP > 25 mmHg, cerebral perfusion pressure (CPP) < 60 mmHg, plasma-Na+ < 150 mOsm and > 4 hours since the last HS/HHES treatment) were prospectively enrolled in the study and received between one and ten bolus infusions of maximal 250 ml HS/HHES at a rate of 20 ml/min. A total of 32 infusions were given. Administration of HS/HHES significantly lowered ICP by 44% and improved CPP by 38% to well above 70 mmHg at 30 min without affecting arterial blood pressure or blood gases. Plasma sodium normalized within 30 min. Experimental studies from our laboratory indicate that the ICP lowering effect is primarily due to dehydration of brain tissue and that cerebral blood volume remains largely unaffected by HS. In summary, HS/HHES reduces otherwise therapy-resistant intracranial hypertension and improves cerebral perfusion even after repeated administration without negatively affecting blood pressure or causing a rebound ICP increase.
DOI	10.1007/978-3-7091-6837-0_39
PubMed ID	9416299