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Controlled Cortical Impact Model for Traumatic Brain Injury
Published on: August 5, 2014
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Hypertonic saline administration and complex traumatic brain injury outcomes: a retrospective study
C Michael Dunham1, Rema J Malik2, Gregory S Huang1
1Trauma, Critical Care, General Surgery Services, St. Elizabeth Youngstown Hospital, Level I Trauma Center 1044 Belmont Ave., Youngstown, OH 44501, USA.
International Journal of Burns and Trauma
|July 26, 2018
Summary
Hypertonic saline (HTS) administration in patients with traumatic brain injury (TBI) is linked to better survival and neurologic function. Larger HTS doses correlate with improved outcomes, including reduced mortality and enhanced recovery of cognitive abilities.
Area of Science:
- Neurosurgery
- Critical Care Medicine
- Trauma Surgery
Background:
- Hypertonic saline (HTS) is used to manage intracranial pressure (ICP) in traumatic brain injury (TBI).
- The impact of HTS on TBI patient survival and long-term neurological function remains less clear.
- This study investigates the association between HTS dosage and TBI patient outcomes.
Purpose of the Study:
- To assess the effect of HTS administration on TBI outcomes.
- To determine if higher doses of 3% saline are associated with favorable neurological function and survival.
- To explore the relationship between HTS administration and specific TBI patient subgroups.
Main Methods:
- Retrospective analysis of 112 TBI patients (age 18-70) with intracranial hemorrhage and Glasgow Coma Scale (GCS) 3-12, requiring mechanical ventilation ≥ 5 days.
- Data collected on HTS amounts administered within the first 5 days at the trauma center.
- Outcomes analyzed included trauma center mortality and ability to follow commands at 3 months, stratified by surgical decompression, ICP levels, and specific injury types.
Main Results:
- In surgically decompressed patients, higher sodium intake (> 8.0 mEq/kg) was associated with lower mortality (7.5% vs. 38.9%) and better 3-month command following (76.9% with ≥ 1400 mEq vs. 50.0%).
- Among non-decompressed survivors without ICP devices, those following commands received significantly more sodium (513 ± 784 mEq vs. 82 ± 144 mEq).
- Patients with GCS 5-8 and those with subdural hematoma or cerebral contusion showed improved 3-month command following with higher sodium administration (≥ 1350-1400 mEq).
- Adequate HTS administration (16.5 ± 11.5 mEq/kg) correlated with shorter durations of ICP elevation (> 20 mmHg).
Conclusions:
- HTS administration in complex TBI patients is associated with mitigation of intracranial hypertension.
- Increased HTS dosage correlates with improved trauma center survival rates.
- Higher HTS administration is linked to better neurological recovery, evidenced by improved ability to follow commands at 3 months post-injury.
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