TY - JOUR
T1 - Hypertonic saline for treating raised intracranial pressure
T2 - Literature review with meta-analysis: A review
AU - Mortazavi, Martin M.
AU - Romeo, Andrew K.
AU - Deep, Aman
AU - Griessenauer, Christoph J.
AU - Shoja, Mohamm Adali M.
AU - Tubbs, R. Shane
AU - Fisher, Winfield
PY - 2012/1
Y1 - 2012/1
N2 - Object. Currently, mannitol is the recommended first choice for a hyperosmolar agent for use in patients with elevated intracranial pressure (ICP). Some authors have argued that hypertonic saline (HTS) might be a more effective agent; however, there is no consensus as to appropriate indications for use, the best concentration, and the best method of delivery. To answer these questions better, the authors performed a review of the literature regarding the use of HTS for ICP reduction. Methods. A PubMed search was performed to locate all papers pertaining to HTS use. This search was then narrowed to locate only those clinical studies relating to the use of HTS for ICP reduction. Results. A total of 36 articles were selected for review. Ten were prospective randomized controlled trials (RCTs), 1 was prospective and nonrandomized, 15 were prospective observational trials, and 10 were retrospective trials. The authors did not distinguish between retrospective observational studies and retrospective comparison trials. Prospective studies were considered observational if the effects of a treatment were evaluated over time but not compared with another treatment. Conclusions. The available data are limited by low patient numbers, limited RCTs, and inconsistent methods between studies. However, a greater part of the data suggest that HTS given as either a bolus or continuous infusion can be more effective than mannitol in reducing episodes of elevated ICP. A meta-analysis of 8 prospective RCTs showed a higher rate of treatment failure or insufficiency with mannitol or normal saline versus HTS.
AB - Object. Currently, mannitol is the recommended first choice for a hyperosmolar agent for use in patients with elevated intracranial pressure (ICP). Some authors have argued that hypertonic saline (HTS) might be a more effective agent; however, there is no consensus as to appropriate indications for use, the best concentration, and the best method of delivery. To answer these questions better, the authors performed a review of the literature regarding the use of HTS for ICP reduction. Methods. A PubMed search was performed to locate all papers pertaining to HTS use. This search was then narrowed to locate only those clinical studies relating to the use of HTS for ICP reduction. Results. A total of 36 articles were selected for review. Ten were prospective randomized controlled trials (RCTs), 1 was prospective and nonrandomized, 15 were prospective observational trials, and 10 were retrospective trials. The authors did not distinguish between retrospective observational studies and retrospective comparison trials. Prospective studies were considered observational if the effects of a treatment were evaluated over time but not compared with another treatment. Conclusions. The available data are limited by low patient numbers, limited RCTs, and inconsistent methods between studies. However, a greater part of the data suggest that HTS given as either a bolus or continuous infusion can be more effective than mannitol in reducing episodes of elevated ICP. A meta-analysis of 8 prospective RCTs showed a higher rate of treatment failure or insufficiency with mannitol or normal saline versus HTS.
KW - Hyperosmolar agent
KW - Hypertonic saline
KW - Intracranial pressure
KW - Mannitol
KW - Trauma
KW - Traumatic brain injury
KW - Treatment evaluation
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U2 - 10.3171/2011.7.JNS102142
DO - 10.3171/2011.7.JNS102142
M3 - Review article
C2 - 21942722
AN - SCOPUS:84855377245
SN - 0022-3085
VL - 116
SP - 210
EP - 221
JO - Journal of neurosurgery
JF - Journal of neurosurgery
IS - 1
ER -