Document Detail

Hypertonic saline solutions for treatment of intracranial hypertension.
MedLine Citation:
PMID:  17873594     Owner:  NLM     Status:  MEDLINE    
PURPOSE OF REVIEW: This review aims to provide an update on recent knowledge gained on hypertonic saline solutions for the treatment of intracranial hypertension. Explanatory approaches to the mechanisms underlying the edema-reducing effects of the solutions are outlined, practical aspects of use are presented, and trials that assessed their clinical utility are highlighted. RECENT FINDINGS: With an established trauma system, hypertonic saline added to conventional fluid resuscitation did not improve long-term outcome in multiple injury with hypotension and brain trauma. In intensive care, hypertonic saline reduced intracranial hypertension after subarachnoid haemorrhage, brain trauma, and a variety of other brain diseases, including cerebral edema in acute liver failure. SUMMARY: Hypertonic saline solutions have evolved as an alternative to mannitol or may be used in otherwise refractory intracranial hypertension to treat raised intracranial pressure. With high osmolar loads, the efficacy of the solution is enhanced, but no simple relationship between the saline concentration and the clinical effects of a solution is established. Caution is advised with high osmolar loads because they carry increased risks for potentially deleterious consequences of hypernatremia or may induce osmotic blood-brain barrier opening with possibly harmful extravasation of the hypertonic solution into the brain tissue.
Sabine Himmelseher
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Publication Detail:
Type:  Journal Article; Review    
Journal Detail:
Title:  Current opinion in anaesthesiology     Volume:  20     ISSN:  0952-7907     ISO Abbreviation:  Curr Opin Anaesthesiol     Publication Date:  2007 Oct 
Date Detail:
Created Date:  2007-09-17     Completed Date:  2008-03-10     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8813436     Medline TA:  Curr Opin Anaesthesiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  414-26     Citation Subset:  IM    
Department of Anaesthesiology, Klinikum rechts der Isar, Ismanigerstrasse 22, D-81675 Munich, Germany.
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MeSH Terms
Brain Injuries / complications*
Cerebrovascular Circulation / drug effects*
Diuretics, Osmotic / therapeutic use
Drug Monitoring / methods
Hetastarch / therapeutic use
Infusions, Intravenous
Intracranial Hypertension / drug therapy*,  etiology,  physiopathology
Mannitol / therapeutic use
Osmolar Concentration
Plasma Substitutes / therapeutic use
Reference Values
Saline Solution, Hypertonic / therapeutic use*
Sodium / blood
Treatment Outcome
Reg. No./Substance:
0/Diuretics, Osmotic; 0/Plasma Substitutes; 0/Saline Solution, Hypertonic; 69-65-8/Mannitol; 7440-23-5/Sodium; 9005-27-0/Hetastarch

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