Hypertonic Saline for Increased Intracranial Pressure After Aneurysmal Subarachnoid Hemorrhage: A Systematic Review.

Abstract

BACKGROUND:

The use of hyperosmolar agents, such as mannitol or hypertonic saline (HTS), to control high intracranial pressure (ICP) in patients with traumatic brain injury has been well studied. However, the role of HTS in the management of aneurysmal subarachnoid hemorrhage (aSAH)-associated increased ICP is still unclear.

METHODS:

We performed a systematic review in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The primary outcome of this review is to quantify ICP reduction produced by HTS and its effect on clinical outcomes defined by any standardized functional score. Secondary outcomes included HTS versus mannitol in ICP reduction, HTS effects on cerebral vasospasm, and HTS dose concentration, infusion rate, infusion volume, frequency of redosing, and serum sodium/osmolality limits for repeat dosing.

RESULTS:

Five studies were included in the review encompassing 175 patients. Studies on aSAH included mostly poor grade patients (defined as World Federation of Neurosurgical Societies grade 4 and 5). HTS concentrations ranged from 3%-23.5%. Most studies found that HTS decreased ICP when compared with either baseline or placebo. The mean decrease in ICP from HTS administration was 8.9 mm Hg (range: 3.3-12.1 mm Hg). Only 1 study showed possible improvement in poor grade aSAH outcomes.

CONCLUSIONS:

The current evidence suggests that HTS is as effective as mannitol at reducing increased ICP in aSAH. However, there is not enough data to recommend the optimal and safest dose concentration or whether HTS significantly improves outcomes in aSAH.

• Authors: Christopher R Pasarikovski, Naif M Alotaibi, Fawaz Al-Mufti, R Loch Macdonald
• Journal: World neurosurgery (World Neurosurg) Vol. 105 Pg. 1-6 (Sep 2017) ISSN: 1878-8769 [Electronic] United States
• PMID: 28549643 (Publication Type: Journal Article, Review, Systematic Review)
• Copyright: Copyright © 2017 Elsevier Inc. All rights reserved.

Chemical References

• Saline Solution, Hypertonic
• Mannitol

Topics

• Brain Injuries (complications, drug therapy)
• Humans
• Intracranial Hypertension (complications, physiopathology, therapy)
• Intracranial Pressure (physiology)
• Mannitol (administration & dosage, therapeutic use)
• Saline Solution, Hypertonic (administration & dosage, therapeutic use)
• Subarachnoid Hemorrhage (complications, therapy)