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Clinical effects of hypertonic saline boluses in children with severe traumatic brain injury
Claire Read1,2, Andrew Wignell1,3, Craig Stewart1
1Paediatric Critical Care Unit, Nottingham Children's Hospital, Nottingham, United Kingdom.
Insights
Three percent hypertonic saline (HTS) effectively lowers intracranial pressure (ICP) and boosts cerebral perfusion pressure (CPP) in pediatric neurocritical care. This osmolar therapy provides sustained benefits for up to three hours post-administration.
Area of Science:
- Pediatric neurocritical care
- Neurosurgery
- Pharmacology
Background:
- Elevated intracranial pressure (ICP) and compromised cerebral perfusion pressure (CPP) are critical concerns in pediatric neurocritical care.
- Osmolar therapy is a cornerstone in managing increased ICP, with hypertonic saline (HTS) being a commonly used agent.
Purpose of the Study:
- To quantify the effects of 3% hypertonic saline (HTS) boluses on ICP and CPP in pediatric patients.
- To determine the duration of HTS effects on ICP and CPP.
- To investigate the correlation between pre-bolus serum sodium concentration and HTS efficacy.
Main Methods:
- Retrospective study design.
- Inclusion of patients admitted to a regional neurosurgical children's intensive care unit.
- Analysis of 156 HTS boluses administered to children with traumatic brain injury.
Main Results:
- A 6 mmHg decrease in ICP (P < 0.01) and a 4 mmHg increase in CPP (P = 0.003) were observed 1-hour post-bolus.
- Sustained effects noted up to 3 hours, with ICP 5 mmHg lower and CPP 3 mmHg higher.
- No significant association found between pre-bolus serum sodium levels and the magnitude of ICP change.
Conclusions:
- 3% HTS at 5 mL/kg is an effective osmolar therapy for reducing ICP and increasing CPP in children.
- The therapeutic effects of HTS can persist for up to 3 hours.
- The '5-5-3' guideline (5 mL/kg of 3% HTS for at least 5 mmHg ICP reduction for 3 hours) is supported, and pre-bolus serum sodium concentration does not predict treatment response.
Aim:
To quantify the effects of 3% hypertonic saline (HTS) boluses on intracranial pressure (ICP) and cerebral perfusion pressure (CPP) in children.
Methods:
A retrospective study of patients admitted to a regional neurosurgical children's intensive care unit.
Results:
A total of 156 HTS boluses were given to children with traumatic brain injury. ICP decreased 6 mmHg (P < 0.01) and CPP increased 4 mmHg (P = 0.003) 1-h post-bolus. Effects persisted for 3 h post-dose ICP was 5 mmHg lower) and 4 h post-bolus CPP was 3 mmHg higher. ICP change was not associated with pre-bolus serum sodium concentration.
Conclusions:
Hypertonic saline 3% at 5 mL/kg is an effective osmolar therapy for reducing ICP and increasing CPP in children for up to 3 h. '53-53' is a suitable guide - 5 mL/kg of 3% HTS will on average decrease ICP by at least 5 mmHg for 3 h. Pre-bolus serum sodium concentration is not correlated with effect size.
