Journal
CRITICAL CARE MEDICINE
Volume 28, Issue 4, Pages 1136-1143Publisher
LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1097/00003246-200004000-00037
Keywords
hypertonic saline; mannitol; intracranial pressure; sodium; osmolarity; creatinine; Glasgow Coma Scale; Glasgow Outcome Scale; computed tomography; closed head injury
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Objective: To determine the effects continuous infusions of hypertonic saline (3% NaCl) on intracranial pressure (ICP) control and describe the physiologic effects of hypertonic saline administered to closed head injury children. Design: Retrospective chart review. Settings: Pediatric intensive care unit of a children's hospital. Patients: Sixty-eight children with closed head injury. Intervention: Intravenous infusion of 3% hypertonic saline to increase serum sodium to levels necessary to reduce ICP less than or equal to 20 mm Hg. Measurements and Main Results:The patients enrolled had similar injury Severity Scares. Treatment effectively lowered ICP in these patients and ICP was under goad control a majority of the time. Only three patients (4%) died of uncontrolled elevation of ICP, No adverse effects of supraphysiologic hyperosmolarity such as renal failure, pulmonary edema, or central pontine demyelination, were noted. Conclusions: Hypertonic saline administration to children with closed head injury appears to be a promising therapy for control of cerebral edema. Further controlled trials are required to determine the optimal duration of treatment before widespread use is advocated.
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