Continuous controlled-infusion of hypertonic saline solution in traumatic brain-injured patients: a 9-year retrospective study

• Published in: Critical care (London, England) Vol. 15; no. 5; p. R260
• Main Authors: Roquilly, Antoine, Mahe, Pierre Joachim, Latte, Dominique Demeure Dit, Loutrel, Olivier, Champin, Philippe, Di Falco, Christelle, Courbe, Athanase, Buffenoir, Kevin, Hamel, Olivier, Lejus, Corinne, Sebille, Véronique, Asehnoune, Karim
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 01-01-2011; BioMed Central
• Subjects: Adult; Brain; Brain Injuries - blood; Brain Injuries - physiopathology; Brain Injuries - therapy; Care and treatment; Diagnosis; Dose-Response Relationship, Drug; Female; Fluid Therapy - methods; Health aspects; Humans; Infusions, Intravenous - methods; Injuries; Intracranial hypertension; Intracranial Hypertension - blood; Intracranial Hypertension - complications; Male; Middle Aged; Physiologic salines; Retrospective Studies; Risk factors; Saline Solution, Hypertonic - administration & dosage; Sodium - blood; Treatment Outcome; France
• ISSN: 1364-8535; 1466-609X; 1364-8535
• DOI: 10.1186/cc10522

Description of a continuous hypertonic saline solution (HSS) infusion using a dose-adaptation of natremia in traumatic brain injured (TBI) patients with refractory intracranial hypertension (ICH).
We performed a single-center retrospective study in a surgical intensive care unit of a tertiary hospital. Fifty consecutive TBI patients with refractory ICH treated with continuous HSS infusion adapted to a target of natremia. In brief, a physician set a target of natremia adapted to the evolution of intracranial pressure (ICP). Flow of NaCl 20% was a priori calculated according to natriuresis, and the current and target natremia that were assessed every 4 hours.
The HSS infusion was initiated for a duration of 7 (5 to 10) (8 ± 4) days. ICP decreased from 29 (26 to 34) (31 ± 9) mm Hg at H0 to 20 (15 to 26) (21 ± 8) mm Hg at H1 (P < 0.05). Cerebral perfusion pressure increased from 61 (50 to 70) (61 ± 13) mm Hg at H0 up to 67 (60 to 79) (69 ± 12) mm Hg at H1 (P < 0.05). No rebound of ICH was reported after stopping continuous HSS infusion. Natremia increased from 140 (138 to 143) (140 ± 4) at H0 up to 144 (141 to 148) (144 ± 4) mmol/L at H4 (P < 0.05). Plasma osmolarity increased from 275 (268 to 281) (279 ± 17) mmol/L at H0 up to 290 (284 to 307) (297 ± 17) mmol/L at H24 (P < 0.05). The main side effect observed was an increase in chloremia from 111 (107 to 119) (113 ± 8) mmol/L at H0 up to 121 (117 to 124) (121 ± 6) mmol/L at H24 (P < 0.05). Neither acute kidney injury nor pontine myelinolysis was recorded.
Continuous HSS infusion adapted to close biologic monitoring enables long-lasting control of natremia in TBI patients along with a decreased ICP without any rebound on infusion discontinuation.