Clinical effects of hypertonic saline boluses in children with severe traumatic brain injury. (23rd August 2021)

• Record Type: Journal Article
• Authors: Read, Claire; Wignell, Andrew; Stewart, Craig; Davies, Patrick
• Is Part Of: Journal of paediatrics and child health. Volume 58:Number 2(2022)
• Page Start: 256
• Page End: 260
• Publication Date: 2021-08-23
• Subjects: cerebral perfusion pressure -- hyperosmolar agent -- hypertonic saline -- mean arterial pressure -- raised intracranial pressure -- traumatic brain injury; Children -- Health and hygiene -- Periodicals; Pediatrics -- Periodicals; 618.92
• DOI: 10.1111/jpc.15695
• Languages: English
• ISSNs: 1034-4810

Abstract

Abstract : Aim: To quantify the effects of 3% hypertonic saline (HTS) boluses on intracranial pressure (ICP) and cerebral perfusion pressure (CPP) in children. Methods: A retrospective study of patients admitted to a regional neurosurgical children's intensive care unit. Results: A total of 156 HTS boluses were given to children with traumatic brain injury. ICP decreased 6 mmHg ( P < 0.01) and CPP increased 4 mmHg ( P = 0.003) 1‐h post‐bolus. Effects persisted for 3 h post‐dose ICP was 5 mmHg lower) and 4 h post‐bolus CPP was 3 mmHg higher. ICP change was not associated with pre‐bolus serum sodium concentration. Conclusions: Hypertonic saline 3% at 5 mL/kg is an effective osmolar therapy for reducing ICP and increasing CPP in children for up to 3 h. '53–53' is a suitable guide – 5 mL/kg of 3% HTS will on average decrease ICP by at least 5 mmHg for 3 h. Pre‐bolus serum sodium concentration is not correlated with effect size.