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Crit Care Med. 2000 Apr;28(4):1136-43.

Prolonged hypernatremia controls elevated intracranial pressure in head-injured pediatric patients.

Author information

1
Department of Critical Care and Anesthesia, San Diego Children's Hospital, CA 92123, USA.

Abstract

OBJECTIVE:

To determine the effects continuous infusions of hypertonic saline (3% NaCl) on intracranial pressure (ICP) control and describe the physiologic effects of hypertonic saline administered to closed head injury children.

DESIGN:

Retrospective chart review.

SETTINGS:

Pediatric intensive care unit of a children's hospital.

PATIENTS:

Sixty-eight children with closed head injury.

INTERVENTIONS:

Intravenous infusion of 3% hypertonic saline to increase serum sodium to levels necessary to reduce ICP < or =20 mm Hg.

MEASUREMENTS AND MAIN RESULTS:

The patients enrolled had similar Injury Severity Scores. Treatment effectively lowered ICP in these patients and ICP was under good control a majority of the time. Only three patients (4%) died of uncontrolled elevation of ICP. No adverse effects of supraphysiologic hyperosmolarity such as renal failure, pulmonary edema, or central pontine demyelination, were noted.

CONCLUSIONS:

Hypertonic saline administration to children with closed head injury appears to be a promising therapy for control of cerebral edema. Further controlled trials are required to determine the optimal duration of treatment before widespread use is advocated.

PMID:
10809295
[Indexed for MEDLINE]

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