Prolonged hypernatremia controls elevated intracranial pressure in head-injured pediatric patients

B Peterson, S Khanna, B Fisher, L Marshall
Critical Care Medicine 2000, 28 (4): 1136-43

OBJECTIVE: To determine the effects continuous infusions of hypertonic saline (3% NaCl) on intracranial pressure (ICP) control and describe the physiologic effects of hypertonic saline administered to closed head injury children.

DESIGN: Retrospective chart review.

SETTINGS: Pediatric intensive care unit of a children's hospital.

PATIENTS: Sixty-eight children with closed head injury.

INTERVENTIONS: Intravenous infusion of 3% hypertonic saline to increase serum sodium to levels necessary to reduce ICP < or =20 mm Hg.

MEASUREMENTS AND MAIN RESULTS: The patients enrolled had similar Injury Severity Scores. Treatment effectively lowered ICP in these patients and ICP was under good control a majority of the time. Only three patients (4%) died of uncontrolled elevation of ICP. No adverse effects of supraphysiologic hyperosmolarity such as renal failure, pulmonary edema, or central pontine demyelination, were noted.

CONCLUSIONS: Hypertonic saline administration to children with closed head injury appears to be a promising therapy for control of cerebral edema. Further controlled trials are required to determine the optimal duration of treatment before widespread use is advocated.

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