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Hypertonic saline lowers raised intracranial pressure in children after head trauma

B Fisher1, D Thomas, B Peterson

  • 1Department of Critical Care, Children's Hospital of San Diego, San Diego, California 92123, USA.

Journal of Neurosurgical Anesthesiology
|January 1, 1992
PubMed

Insights

3% saline effectively reduces high intracranial pressure (ICP) in pediatric traumatic brain injury patients. This hypertonic saline solution offers a significant ICP reduction compared to 0.9% saline without causing dehydration.

Area of Science:

  • Pediatric critical care
  • Neurotrauma management
  • Intensive care medicine

Background:

  • Traumatic brain injury (TBI) in children often leads to elevated intracranial pressure (ICP).
  • Managing increased ICP is crucial for improving outcomes in pediatric TBI.
  • Hypertonic saline solutions are explored for their potential in ICP reduction.

Purpose of the Study:

  • To compare the efficacy of 3% saline versus 0.9% saline in reducing elevated ICP in pediatric TBI patients.
  • To assess the safety and physiological effects of 3% saline infusion on ICP.
  • To evaluate changes in central venous pressure and renal function during saline administration.

Main Methods:

  • Double-blind, crossover study involving 18 pediatric patients with TBI.
  • Administration of bolus infusions of 3% saline and 0.9% saline.
  • Continuous ICP monitoring for 2 hours post-infusion for each saline type.

Main Results:

  • 3% saline significantly reduced mean ICP from a baseline of 19.9 mm Hg to 15.8 mm Hg (p = 0.003).
  • 0.9% saline did not significantly alter mean ICP (19.3 mm Hg baseline to 20.0 mm Hg).
  • No significant changes in central venous pressure or renal function were observed; serum sodium increased with 3% saline.

Conclusions:

  • 3% saline is an effective treatment for reducing elevated ICP in pediatric patients with traumatic brain injury.
  • Hypertonic saline (3%) demonstrates a significant ICP-lowering effect compared to isotonic saline (0.9%).
  • 3% saline administration in this context did not lead to intravascular dehydration.

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