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Hypertonic saline in elevated intracranial pressure: past, present, and future
Salim Surani1, Geoff Lockwood2, Melissa Y Macias2
1Division of Pulmonary and Critical Care Medicine, Texas A&M University, TX, USA srsurani@hotmail.com.
Journal of Intensive Care Medicine
|June 12, 2013
Summary
Hypertonic saline (HS) effectively managed elevated intracranial pressure (ICP) in a patient with a brain arteriovenous malformation. This case highlights HS as a safe and viable alternative to mannitol for ICP control.
Area of Science:
- Neurosurgery
- Neurology
- Critical Care Medicine
Background:
- Elevated intracranial pressure (ICP) is a critical complication following neurosurgical procedures.
- Mannitol is a traditional osmotic agent for ICP reduction, but alternatives are sought.
- Hypertonic saline (HS) offers a potential alternative for managing increased ICP.
Observation:
- A 25-year-old female presented with an intracranial bleed due to a right parietal arteriovenous malformation.
- Post-operatively, the patient experienced recurrent episodes of elevated ICP after surgical intervention.
- The patient received both 23.4% hypertonic saline and mannitol for ICP management.
Findings:
- Hypertonic saline was administered in 17 doses, alongside 30 doses of mannitol.
- The combined treatment regimen resulted in a positive clinical outcome for the patient.
- Despite some clinical hesitancy, HS demonstrated efficacy in this case.
Implications:
- This case supports the use of hypertonic saline as a safe and effective therapeutic option for elevated ICP.
- Further research may explore optimal dosing and combination strategies involving HS.
- Hypertonic saline presents a valuable alternative in the neurocritical care armamentarium for ICP management.
Keywords:
cerebral edemahypertonic salineintracranial hypertensionintracranial pressuremannitolstrokeMore Related Videos
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