Related Experiment Video
Updated: Dec 24, 2025
Description of a Swine Infant Model of Volume-Controlled Hemorrhagic Shock
Published on: November 3, 2023
Concentrated hypertonic saline in severe pediatric traumatic brain injury
Ethan J Sabers1, Pamela D Reiter2, Heather E Skillman3
1Clinical Pharmacist, Acute Pharmaceutical Care, Department of Pharmaceutical Care, University of Iowa Stead Family Children's Hospital, University of Iowa Health Care , Iowa City, IA, USA.
Insights
Hypertonic saline (HTS) effectively reduces intracranial pressure in children with severe traumatic brain injury (TBI). Higher concentrations of HTS may improve fluid balance and nutritional intake while reducing pulmonary edema.
Area of Science:
- Pediatric Critical Care
- Neuroscience
- Emergency Medicine
Background:
- Severe traumatic brain injury (TBI) in children can lead to increased intracranial pressure (ICP).
- Management of elevated ICP is crucial for improving outcomes in pediatric TBI.
- Hypertonic saline (HTS) is a therapeutic option for managing intracranial hypertension.
Purpose of the Study:
- To describe outcomes associated with bolus and continuous infusions of hypertonic saline (HTS) in children with severe TBI.
- To evaluate the efficacy of different concentrations of HTS in reducing ICP.
- To assess the impact of HTS on fluid balance, pulmonary edema, and nutritional intake.
Main Methods:
- Retrospective review of pediatric patients with severe TBI admitted between 2012 and 2018.
- Analysis of data from 45 children who received HTS for acute intracranial hypertension.
- Comparison of outcomes based on HTS administration via bolus or continuous infusion and varying concentrations.
Main Results:
- Equiosmolar bolus doses of HTS significantly reduced ICP at 30, 60, and 120 minutes post-administration.
- The 12% HTS concentration showed the greatest ICP reduction.
- Continuous HTS infusions were associated with improved fluid balance, reduced pulmonary edema, and increased protein and energy intake.
Conclusions:
- Bolus doses of concentrated HTS are effective in significantly reducing ICP in pediatric severe TBI.
- Continuous HTS infusions, particularly at higher concentrations, may offer additional benefits including improved fluid management and nutritional support.
- HTS represents a valuable therapeutic agent in the management of severe TBI in children.
Objective:
Describe outcomes associated with bolus and continuous infusions of hypertonic saline (HTS) in children with severe traumatic brain injury (TBI).
Methods:
IRB-approved, single-center, retrospective review of children admitted between January 1, 2012 to August 30, 2018 with a diagnosis of severe TBI who received HTS.
Results:
Forty-five children (age 9.3 ± 5.8 yr; 60% male) met inclusion criteria. One-hundred eighty-nine equiosmolar bolus doses of HTS were administered to 43 patients (3% HTS, n = 84 doses; 6% HTS, n = 38 doses; 12% HTS, n = 67 doses) for episodes of acute intracranial hypertension (pressure above 20 mmHg). Significant reductions in ICP were observed at 30, 60, and 120 min following HTS boluses with the greatest decrease observed in patients receiving 12%. Thirty-four patients received a continuous infusion of HTS. Higher concentrations of HTS were associated with a more favorable fluid balance (p < .001), fewer episodes of pulmonary edema (p = .003), and higher intake of protein and energy (p < .001).
Conclusions:
Equiosmolar bolus doses of concentrated HTS were associated with significant reductions in ICP. Benefits of higher concentrations of continuous HTS may include improved fluid balance, less pulmonary edema, and greater amounts of protein and energy intake.
