Continuous controlled-infusion of hypertonic saline solution in traumatic brain-injured patients: a 9-year retrospective study.

Abstract

INTRODUCTION:

Description of a continuous hypertonic saline solution (HSS) infusion using a dose-adaptation of natremia in traumatic brain injured (TBI) patients with refractory intracranial hypertension (ICH).

METHODS:

We performed a single-center retrospective study in a surgical intensive care unit of a tertiary hospital. Fifty consecutive TBI patients with refractory ICH treated with continuous HSS infusion adapted to a target of natremia. In brief, a physician set a target of natremia adapted to the evolution of intracranial pressure (ICP). Flow of NaCl 20% was a priori calculated according to natriuresis, and the current and target natremia that were assessed every 4 hours.

RESULTS:

The HSS infusion was initiated for a duration of 7 (5 to 10) (8 ± 4) days. ICP decreased from 29 (26 to 34) (31 ± 9) mm Hg at H0 to 20 (15 to 26) (21 ± 8) mm Hg at H1 (P < 0.05). Cerebral perfusion pressure increased from 61 (50 to 70) (61 ± 13) mm Hg at H0 up to 67 (60 to 79) (69 ± 12) mm Hg at H1 (P < 0.05). No rebound of ICH was reported after stopping continuous HSS infusion. Natremia increased from 140 (138 to 143) (140 ± 4) at H0 up to 144 (141 to 148) (144 ± 4) mmol/L at H4 (P < 0.05). Plasma osmolarity increased from 275 (268 to 281) (279 ± 17) mmol/L at H0 up to 290 (284 to 307) (297 ± 17) mmol/L at H24 (P < 0.05). The main side effect observed was an increase in chloremia from 111 (107 to 119) (113 ± 8) mmol/L at H0 up to 121 (117 to 124) (121 ± 6) mmol/L at H24 (P < 0.05). Neither acute kidney injury nor pontine myelinolysis was recorded.

CONCLUSIONS:

Continuous HSS infusion adapted to close biologic monitoring enables long-lasting control of natremia in TBI patients along with a decreased ICP without any rebound on infusion discontinuation.

• Authors: Antoine Roquilly, Pierre Joachim Mahe, Dominique Demeure Dit Latte, Olivier Loutrel, Philippe Champin, Christelle Di Falco, Athanase Courbe, Kevin Buffenoir, Olivier Hamel, Corinne Lejus, Véronique Sebille, Karim Asehnoune
• Journal: Critical care (London, England) (Crit Care) Vol. 15 Issue 5 Pg. R260 ( 2011) ISSN: 1466-609X [Electronic] England
• PMID: 22035596 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Saline Solution, Hypertonic
• Sodium

Topics

• Adult
• Brain Injuries (blood, physiopathology, therapy)
• Dose-Response Relationship, Drug
• Female
• Fluid Therapy (methods)
• Humans
• Infusions, Intravenous (methods)
• Intracranial Hypertension (blood, complications)
• Male
• Middle Aged
• Retrospective Studies
• Saline Solution, Hypertonic (administration & dosage)
• Sodium (blood)
• Treatment Outcome