Comparison of Weight-Based Dosing versus Fixed Dosing of 23.4% Hypertonic Saline for Intracranial Pressure Reduction in Patients with Severe Traumatic Brain Injury.

CONTEXT

Hypertonic saline (HTS) is a pharmacologic therapy used in patients with severe traumatic brain injuries to decrease intracranial pressure (ICP) associated with cerebral edema.

AIMS

The purpose of this study was to compare ICP reduction between fixed doses of 23.4% HTS and weight-based doses.

SETTING AND DESIGN

This was a retrospective study that included adult patients at a level 1 trauma center who had nonpenetrating traumatic brain injury, an ICP monitor, and received at least one dose of 23.4% HTS.

SUBJECTS AND METHODS

Doses were classified as either high weight-based (>0.6 ml/kg), low weight-based (<0.6 ml/kg), or standard fixed dose (30 ml). Only doses given within 5 days post-injury were evaluated. Percent reduction in ICP was compared pre- and post-dose between dosing groups, and each dose was evaluated as a separate episode.

STATISTICAL ANALYSIS

The primary and secondary endpoints for the study were analyzed using mixed-model, repeated-measures analysis of covariance.

RESULTS

A total of 97 doses of HTS were evaluated. The primary endpoint of ICP reduction showed a 42.5% decrease in ICP after the administration of a high weight-based dose, a 36.7% reduction after a low weight-based dose, and a 31.5% reduction after a fixed dose. There was no significant relationship between dose group and percent change in ICP ( = 0.25). A sub-analysis of doses received within 48 h postinjury found a significant relationship between both dose group and percent change in ICP, and initial ICP and percent change in ICP ( = 0.04, and <0.0001 respectively).

CONCLUSIONS

Our data did not show a significant difference between fixed- and weight-based doses of 23.4% HTS for ICP reduction.