Hypertonic saline solutions in brain injury

Anish Bhardwaj, John A. Ulatowski

Research output: Contribution to journalArticle

88 Citations (Scopus)

Abstract

Purpose of review: Hypertonic saline solutions have received renewed attention as effective agents for the treatment of cerebral edema and in brain resuscitation in a variety of brain injury paradigms. Although evidence of the beneficial action of hypertonic saline solutions in traumatic brain injury is robust, data supporting use in other conditions are only now mounting. Recent findings: Osmotic properties of hypertonic saline solutions have been well studied in laboratory-based studies in animal models and in patients with acute brain injury. There are, in addition, emerging data on the extraosmotic actions on brain pathophysiology. This review cites baseline literature and provides new evidence of actions of hypertonic saline solutions: (a) in augmenting cerebral blood flow after subarachnoid hemorrhage, (b) as an antiinflammatory adjunct, and (c) utility in chemonucleolysis for intervertebral disc disease and treatment of seizures associated with severe hyponatremia. Summary: Brain injury from diverse etiologies including trauma, ischemic stroke, global cerebral ischemia from cardiac arrest, intraparenchymal or subarachnoid hemorrhage, infection, or toxic-metabolic derangements are commonly encountered in the clinical setting. Many of these conditions are associated with cerebral edema with or without elevated intracranial pressure. Osmotherapy constitutes the cornerstone of medical therapy for such patients. Hypertonic saline solutions have received renewed attention in clinical practice as osmotic agents for cerebral resuscitation. This article reviews experimental and clinical evidence of the efficacy of hypertonic saline solutions and elaborates on their use in patients with acute neurologic injury. Important areas for current and future research are highlighted before the use of hypertonic saline solutions can be accepted for widespread use.

Original languageEnglish (US)
Pages (from-to)126-131
Number of pages6
JournalCurrent Opinion in Critical Care
Volume10
Issue number2
DOIs
StatePublished - Apr 2004
Externally publishedYes

Fingerprint

Hypertonic Saline Solutions
Brain Injuries
Brain Edema
Subarachnoid Hemorrhage
Resuscitation
Cerebrovascular Circulation
Intervertebral Disc Chemolysis
Nervous System Trauma
Intracranial Hypertension
Hyponatremia
Poisons
Brain
Heart Arrest
Brain Ischemia
Seizures
Anti-Inflammatory Agents
Therapeutics
Animal Models
Stroke
Wounds and Injuries

Keywords

  • Brain
  • Cerebral
  • Edema
  • Intracranial pressure
  • Osmotherapy

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

Cite this

Hypertonic saline solutions in brain injury. / Bhardwaj, Anish; Ulatowski, John A.

In: Current Opinion in Critical Care, Vol. 10, No. 2, 04.2004, p. 126-131.

Research output: Contribution to journalArticle

Bhardwaj, Anish ; Ulatowski, John A. / Hypertonic saline solutions in brain injury. In: Current Opinion in Critical Care. 2004 ; Vol. 10, No. 2. pp. 126-131.
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