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Effectiveness of 7.5% hypertonic saline in children with severe traumatic brain injury
Dimitrios Rallis1, Panagiotis Poulos1, Maria Kazantzi1
1Pediatric Intensive Care Unit, "Aghia Sophia" Children's Hospital, Athens, Greece.
Insights
This study found that 7.5% hypertonic saline (HTS) effectively reduced intracranial pressure (ICP) and improved cerebral perfusion pressure (CPP) in children with severe traumatic brain injury (TBI). HTS is a safe and beneficial second-tier osmotic therapy for pediatric TBI management.
Area of Science:
- Pediatric Intensive Care
- Neurocritical Care
- Traumatology
Background:
- Increased intracranial pressure (ICP) is a critical concern in severe traumatic brain injury (TBI).
- Hyperosmolar therapies are essential for managing elevated ICP.
- 7.5% hypertonic saline (HTS) is utilized as an osmotic agent in TBI management.
Purpose of the Study:
- To evaluate the efficacy of 7.5% hypertonic saline (HTS) in controlling ICP.
- To assess the impact of HTS on cerebral perfusion pressure (CPP) in pediatric severe TBI.
- To determine the safety and neurological outcomes associated with HTS use.
Main Methods:
- Retrospective review of medical records for pediatric patients (≤14 years) with severe TBI.
- Analysis of ICP and CPP before and at 30, 60, and 120 minutes after HTS infusion.
- Recording of adverse effects, neurological outcomes, and survival rates.
Main Results:
- Twenty-nine pediatric patients received 136 HTS infusions.
- A significant reduction in ICP and elevation in CPP were observed post-HTS infusion.
- ICP and CPP levels remained within acceptable ranges, with no significant adverse events noted.
Conclusions:
- 7.5% HTS is an effective second-tier osmotic therapy for reducing ICP and increasing CPP in children with severe TBI.
- HTS administration was associated with survival in most patients, though one-third experienced severe neurological impairment.
- Further research into long-term outcomes of HTS in pediatric TBI is warranted.
Purpose:
Hyperosmolar therapies aim at controlling increased intracranial pressure (ICP) in patients with traumatic brain injury (TBI). The aim of this study was to evaluate the effect of 7.5% hypertonic saline (HTS) on ICP and cerebral perfusion pressure (CPP) in children with severe TBI.
Materials And Methods:
Medical records of patients 14 years or younger with severe TBI, admitted in the pediatric intensive care unit of "Aghia Sophia" Children's Hospital, Athens, Greece, during 2009 to 2015, and received HTS apart from mannitol were retrospectively reviewed. The ICP and CPP pre-HTS and 30, 60, and 120 minutes post-HTS infusion were evaluated. Furthermore, the presence of adverse effects, the long-term neurological outcome, and survival were recorded.
Results:
Twenty-nine patients requiring in total 136 HTS infusions were analyzed. The ICP was significantly reduced and CPP elevated at 30, 60, and 120 minutes postinfusion; and furthermore, postadministration ICP and CPP were predominantly within acceptable limits. No significant adverse effects were recorded and most of the patients survived, however, one third had severe neurological impairment at 6 months postinjury.
Conclusions:
In our study, 7.5% HTS infusion as a second-tier osmotic therapy was associated with significant reduction of ICP and increase of CPP in children with severe TBI.
