Use of hypertonic saline/acetate infusion in treatment of cerebral edema in patients with head trauma: Experience at a single center

Adnan I. Qureshi, Jose I. Suarez, Alexjandro Castro, Anish Bhardwaj

Research output: Contribution to journalArticle

77 Citations (Scopus)

Abstract

Background: Hypertonic saline (HS) recently has been introduced as a new form of hyperosmolar treatment in patients with brain injury from diverse causes. We reviewed our experience with the use of continuous hypertonic saline/acetate infusion in patients with cerebral edema attributable to head trauma. Methods: We performed a retrospective chart review of all patients admitted with severe head injury, defined as admission Glasgow Coma Scale score of 8 or less, in the neurocritical care unit of a University hospital. Intravenous infusion of 2% or 3% saline/acetate for treatment of cerebral edema was introduced in the unit in April of 1993. The clinical characteristics, interventions required, and outcomes in patients who received HS were compared with patients who received 0.9% saline infusion only. Multivariate analyses were used to evaluate the impact of HS use on in-hospital mortality and Glasgow Outcome Scale score at discharge. Results: Thirty-six patients with cerebral edema caused by head trauma received infusion of HS initiated within 48 hours of admission for a mean period of 72 ± 85 hours. Compared with 46 patients who did not receive HS, there were no differences observed in age and admission Glasgow Coma Scale scores. Patients who received HS were more likely to have a penetrating injury (p = 0.07) and a mass lesion on initial computed tomographic scan (p = 0.07). There was no difference between frequency of use of hyperventilation, mannitol, cerebrospinal fluid drainage, and vasopressors between the two groups. The requirement for pentobarbital coma was higher in HS group (n = 7 patients) versus control group (n = 2, p = 0.04). After adjusting for differences between both groups, infusion of HS was associated with higher in-hospital mortality (OR, 3.1; 95% CI, 1.1-10.2). Conclusion: HS administration as prolonged infusion does not seem to favorably impact on requirement for other interventions and in-hospital mortality in our experience. Further efforts should be directed toward use of HS as bolus administrations or short infusions.

Original languageEnglish (US)
Pages (from-to)659-665
Number of pages7
JournalJournal of Trauma - Injury, Infection and Critical Care
Volume47
Issue number4
DOIs
StatePublished - Oct 1999
Externally publishedYes

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Brain Edema
Craniocerebral Trauma
Acetates
Hospital Mortality
Glasgow Coma Scale
Therapeutics
Glasgow Outcome Scale
Hyperventilation
Mannitol
Pentobarbital
Coma
Intravenous Infusions
Brain Injuries
Multivariate Analysis
Control Groups
Wounds and Injuries

Keywords

  • Cerebral edema
  • Computed tomography
  • Glasgow Coma Scale
  • Glasgow Outcome Scale
  • Head trauma
  • Hypertonic saline
  • Intracranial pressure
  • Sodium

ASJC Scopus subject areas

  • Surgery

Cite this

Use of hypertonic saline/acetate infusion in treatment of cerebral edema in patients with head trauma : Experience at a single center. / Qureshi, Adnan I.; Suarez, Jose I.; Castro, Alexjandro; Bhardwaj, Anish.

In: Journal of Trauma - Injury, Infection and Critical Care, Vol. 47, No. 4, 10.1999, p. 659-665.

Research output: Contribution to journalArticle

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abstract = "Background: Hypertonic saline (HS) recently has been introduced as a new form of hyperosmolar treatment in patients with brain injury from diverse causes. We reviewed our experience with the use of continuous hypertonic saline/acetate infusion in patients with cerebral edema attributable to head trauma. Methods: We performed a retrospective chart review of all patients admitted with severe head injury, defined as admission Glasgow Coma Scale score of 8 or less, in the neurocritical care unit of a University hospital. Intravenous infusion of 2{\%} or 3{\%} saline/acetate for treatment of cerebral edema was introduced in the unit in April of 1993. The clinical characteristics, interventions required, and outcomes in patients who received HS were compared with patients who received 0.9{\%} saline infusion only. Multivariate analyses were used to evaluate the impact of HS use on in-hospital mortality and Glasgow Outcome Scale score at discharge. Results: Thirty-six patients with cerebral edema caused by head trauma received infusion of HS initiated within 48 hours of admission for a mean period of 72 ± 85 hours. Compared with 46 patients who did not receive HS, there were no differences observed in age and admission Glasgow Coma Scale scores. Patients who received HS were more likely to have a penetrating injury (p = 0.07) and a mass lesion on initial computed tomographic scan (p = 0.07). There was no difference between frequency of use of hyperventilation, mannitol, cerebrospinal fluid drainage, and vasopressors between the two groups. The requirement for pentobarbital coma was higher in HS group (n = 7 patients) versus control group (n = 2, p = 0.04). After adjusting for differences between both groups, infusion of HS was associated with higher in-hospital mortality (OR, 3.1; 95{\%} CI, 1.1-10.2). Conclusion: HS administration as prolonged infusion does not seem to favorably impact on requirement for other interventions and in-hospital mortality in our experience. Further efforts should be directed toward use of HS as bolus administrations or short infusions.",
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AU - Bhardwaj, Anish

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N2 - Background: Hypertonic saline (HS) recently has been introduced as a new form of hyperosmolar treatment in patients with brain injury from diverse causes. We reviewed our experience with the use of continuous hypertonic saline/acetate infusion in patients with cerebral edema attributable to head trauma. Methods: We performed a retrospective chart review of all patients admitted with severe head injury, defined as admission Glasgow Coma Scale score of 8 or less, in the neurocritical care unit of a University hospital. Intravenous infusion of 2% or 3% saline/acetate for treatment of cerebral edema was introduced in the unit in April of 1993. The clinical characteristics, interventions required, and outcomes in patients who received HS were compared with patients who received 0.9% saline infusion only. Multivariate analyses were used to evaluate the impact of HS use on in-hospital mortality and Glasgow Outcome Scale score at discharge. Results: Thirty-six patients with cerebral edema caused by head trauma received infusion of HS initiated within 48 hours of admission for a mean period of 72 ± 85 hours. Compared with 46 patients who did not receive HS, there were no differences observed in age and admission Glasgow Coma Scale scores. Patients who received HS were more likely to have a penetrating injury (p = 0.07) and a mass lesion on initial computed tomographic scan (p = 0.07). There was no difference between frequency of use of hyperventilation, mannitol, cerebrospinal fluid drainage, and vasopressors between the two groups. The requirement for pentobarbital coma was higher in HS group (n = 7 patients) versus control group (n = 2, p = 0.04). After adjusting for differences between both groups, infusion of HS was associated with higher in-hospital mortality (OR, 3.1; 95% CI, 1.1-10.2). Conclusion: HS administration as prolonged infusion does not seem to favorably impact on requirement for other interventions and in-hospital mortality in our experience. Further efforts should be directed toward use of HS as bolus administrations or short infusions.

AB - Background: Hypertonic saline (HS) recently has been introduced as a new form of hyperosmolar treatment in patients with brain injury from diverse causes. We reviewed our experience with the use of continuous hypertonic saline/acetate infusion in patients with cerebral edema attributable to head trauma. Methods: We performed a retrospective chart review of all patients admitted with severe head injury, defined as admission Glasgow Coma Scale score of 8 or less, in the neurocritical care unit of a University hospital. Intravenous infusion of 2% or 3% saline/acetate for treatment of cerebral edema was introduced in the unit in April of 1993. The clinical characteristics, interventions required, and outcomes in patients who received HS were compared with patients who received 0.9% saline infusion only. Multivariate analyses were used to evaluate the impact of HS use on in-hospital mortality and Glasgow Outcome Scale score at discharge. Results: Thirty-six patients with cerebral edema caused by head trauma received infusion of HS initiated within 48 hours of admission for a mean period of 72 ± 85 hours. Compared with 46 patients who did not receive HS, there were no differences observed in age and admission Glasgow Coma Scale scores. Patients who received HS were more likely to have a penetrating injury (p = 0.07) and a mass lesion on initial computed tomographic scan (p = 0.07). There was no difference between frequency of use of hyperventilation, mannitol, cerebrospinal fluid drainage, and vasopressors between the two groups. The requirement for pentobarbital coma was higher in HS group (n = 7 patients) versus control group (n = 2, p = 0.04). After adjusting for differences between both groups, infusion of HS was associated with higher in-hospital mortality (OR, 3.1; 95% CI, 1.1-10.2). Conclusion: HS administration as prolonged infusion does not seem to favorably impact on requirement for other interventions and in-hospital mortality in our experience. Further efforts should be directed toward use of HS as bolus administrations or short infusions.

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KW - Computed tomography

KW - Glasgow Coma Scale

KW - Glasgow Outcome Scale

KW - Head trauma

KW - Hypertonic saline

KW - Intracranial pressure

KW - Sodium

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