Document Detail


Resuscitation of hypotensive head-injured patients: is hypertonic saline the answer?
MedLine Citation:
PMID:  18376694     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Hypertonic saline (HTS) may decrease intracranial pressure (ICP) in severe traumatic brain injury (STBI) and effectively resuscitates hypotensive patients. No data exist on institutional standardization of HTS for hypotensive patients with STBI. It remains unclear how HTS affects brain tissue oxygenation (PbtO2) in STBI. We hypothesized HTS could be safely standardized in patients with STBI and would lower ICP while improving cerebral perfusion pressure (CPP) and PbtO2. Under institutional guidelines in a Level I trauma center, 12 hypotensive STBI intensive care unit subjects received HTS. Inclusion criteria included mean arterial pressure (MAP) < or = 90 mmHg, Glasgow Coma Scale (GCS) < or = 8, ICP > or = 20 mmHg, and serum [Na+] <155 mEq/L. All patients underwent ICP monitoring. Hemodynamics, CPP, ICP, and PbtO2 data were collected before and hourly for 6 hours after HTS infusion. Guideline criteria compliance was greater than 95 per cent. No major complications occurred. Mean ICP levels dropped by 45 per cent (P < 0.01) and this drop persisted for 6 hours. CPP levels increased by 20 per cent (P < 0.05). PbtO2 remained persistently elevated for all time points after HTS infusion. Institutional use of HTS in STBI can be safely implemented in a center caring for neurotrauma patients. HTS infusion in hypotensive STBI reduces ICP and raises CPP. Brain tissue oxygenation tends to improve after HTS infusion.
Authors:
Jose L Pascual; Eileen Maloney-Wilensky; Patrick M Reilly; Corinna Sicoutris; Michael K Keutmann; Sherman C Stein; Peter D LeRoux; Vicente H Gracias
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The American surgeon     Volume:  74     ISSN:  0003-1348     ISO Abbreviation:  Am Surg     Publication Date:  2008 Mar 
Date Detail:
Created Date:  2008-04-01     Completed Date:  2008-04-25     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0370522     Medline TA:  Am Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  253-9     Citation Subset:  IM    
Affiliation:
Division of Traumatology and Surgical Critical Care, Department of Surgery, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA.
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Aged
Brain Injuries / complications,  therapy*
Female
Fluid Therapy*
Glasgow Coma Scale
Humans
Hypotension / etiology,  therapy*
Intracranial Pressure
Male
Saline Solution, Hypertonic / therapeutic use*
Treatment Outcome
Chemical
Reg. No./Substance:
0/Saline Solution, Hypertonic

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


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