Document Detail


Cerebral hemodynamic effects of 7.2% hypertonic saline in patients with head injury and raised intracranial pressure.
MedLine Citation:
PMID:  10674757     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
The aim of the present study was to investigate the acute effects of 7.2% hypertonic saline (HS) on intracranial pressure (ICP), cerebral and systemic hemodynamics, serum sodium, and osmolality in 14 patients with moderate and severe traumatic brain injury (Glasgow Coma Scale < or =13) and raised ICP (>15 mm Hg) within the first 72 h postinjury. After CO2 reactivity and autoregulation were tested, each patient received a 15-min infusion of 7.2% HS (1,232 mEq/L, volume 1.5 mL/kg). ICP, serial hemodynamics, cerebral blood flow (CBF) estimated from cerebral arteriovenous oxygen content difference (AVDO2), and laboratory variables, including serum osmolality, electrolytes, urea, and creatinine were collected before infusion (T0) and at 5, 30, 60, and 120 min after (T5, T30, T60, T120). Urine output was measured 2 h before infusion and at T120. While CO2 reactivity was preserved in all patients, autoregulation was preserved in only four. ICP decreased to about 30% of base line (p = 0.0001) during the whole study period. During the first hour after infusion, cerebral perfusion pressure (p< or =0.04) and cardiac index (CI; p< or =0.01) increased, while systemic vascular resistance index fell (p< or =0.05). Heart rate increased (p< or =0.04) during the first 30 min. Pulmonary artery occlusion pressure (PAOP) increased (p = 0.004) at T5. There were no significant changes in mean arterial blood pressure (MABP), urine output, and estimated CBF. A significant positive correlation (r = 0.75; p = 0.02) between ICP and serum osmolality was found at T5. The administration of 7.2% HS in patients with traumatic brain injury significantly reduces ICP without significant changes in relative global CBF (expressed as 1/AVDO2), increases CI and transiently increases PAOP, without changing MABP and urine output. The correlation between changes in osmolality and ICP supports the hypothesis that HSS may in part decrease ICP by means of an osmotic mechanism.
Authors:
F Munar; A M Ferrer; M de Nadal; M A Poca; S Pedraza; J Sahuquillo; A Garnacho
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Publication Detail:
Type:  Clinical Trial; Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Journal of neurotrauma     Volume:  17     ISSN:  0897-7151     ISO Abbreviation:  J. Neurotrauma     Publication Date:  2000 Jan 
Date Detail:
Created Date:  2000-03-09     Completed Date:  2000-03-09     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  8811626     Medline TA:  J Neurotrauma     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  41-51     Citation Subset:  IM    
Affiliation:
Department of Anesthesiology, Vall d'Hebron University Hospitals, Barcelona, Spain. davaz@i3d.es
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Blood Pressure / drug effects
Brain Injuries / blood,  complications,  drug therapy*
Cerebrovascular Circulation / drug effects*
Chlorides / blood
Female
Hemodynamics / drug effects
Hemoglobins / metabolism
Humans
Infusions, Intravenous
Intracranial Hypertension / drug therapy*,  etiology
Male
Middle Aged
Osmolar Concentration
Potassium / blood
Prospective Studies
Saline Solution, Hypertonic / administration & dosage*
Sodium / blood
Treatment Outcome
Chemical
Reg. No./Substance:
0/Chlorides; 0/Hemoglobins; 0/Saline Solution, Hypertonic; 7440-09-7/Potassium; 7440-23-5/Sodium

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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