Concentrated hypertonic saline in severe pediatric traumatic brain injury

ABSTRACT

Objective

Describe outcomes associated with bolus and continuous infusions of hypertonic saline (HTS) in children with severe traumatic brain injury (TBI).

Methods

IRB-approved, single-center, retrospective review of children admitted between January 1, 2012 to August 30, 2018 with a diagnosis of severe TBI who received HTS.

Results

Forty-five children (age 9.3 ± 5.8 yr; 60% male) met inclusion criteria. One-hundred eighty-nine equiosmolar bolus doses of HTS were administered to 43 patients (3% HTS, n = 84 doses; 6% HTS, n = 38 doses; 12% HTS, n = 67 doses) for episodes of acute intracranial hypertension (pressure above 20 mmHg). Significant reductions in ICP were observed at 30, 60, and 120 min following HTS boluses with the greatest decrease observed in patients receiving 12%. Thirty-four patients received a continuous infusion of HTS. Higher concentrations of HTS were associated with a more favorable fluid balance (p < .001), fewer episodes of pulmonary edema (p = .003), and higher intake of protein and energy (p < .001).

Conclusions

Equiosmolar bolus doses of concentrated HTS were associated with significant reductions in ICP. Benefits of higher concentrations of continuous HTS may include improved fluid balance, less pulmonary edema, and greater amounts of protein and energy intake.

KEYWORDS:

• Hyperosmolar therapy
• hypertonic saline
• traumatic brain injury
• children

Acknowledgments

The authors would like to acknowledge Colin Maehler, PharmD Candidate 2021 for his valuable contribution to data collection.

Key words for indexing: hyperosmolar therapy, hypertonic saline, traumatic brain injury, children, intensive care

Disclosures/Conflict of Interest

The authors have no financial interests or affiliations with institutions, organizations, or companies relevant to the manuscript. Additionally, financial associations involving our spouse, partner, or children are not present.

Details Page

As the corresponding author, I confirm that this manuscript complies with all instructions to authors and that authorship requirements have been met and the final manuscript was approved by all authors.

This manuscript has not been published elsewhere and is not under consideration by another journal. We have adhered to ethical guidelines and have received IRB approval for this work. A statement regarding IRB approval has been placed within the manuscript.

Disclosure statement

Conflict of Interest statements for all authors are listed below:

Dr Sabers has nothing to disclose

Dr Reiter has nothing to disclose

Ms Skillman has nothing to disclose

Dr DeMasellis has nothing to disclose