Department of Neurosurgery, Ronald Reagan UCLA Medical Center, University of California, Los Angeles, California, USA.
Department of Neurosurgery, Ronald Reagan UCLA Medical Center, University of California, Los Angeles, California, USA; Los Angeles Biomedical Research Institute (LA BioMed) at Harbor-UCLA Medical Center, University of California, Los Angeles, California, USA.
World Neurosurg. 2022 Jun;162:98-110. doi: 10.1016/j.wneu.2022.03.056. Epub 2022 Mar 19.
Hypertonic saline (HTS) is a widely used adjunct in the treatment of traumatic brain injury (TBI). However, there is significant variability in practice patterns. Toward the goal of optimality and standardization in the use of HTS in TBI, we performed a comprehensive review of clinical protocols reported in the neurosurgical and neurocritical care literature. PubMed, Web of Science, Cochrane, Scopus, and Embase were independently queried between October and November 2021. The PRISMA guidelines were used throughout the screening process. We identified 15 high-quality studies representing data from 535 patients. We extracted patient demographics, Glasgow Coma Scale (GCS) score, mechanism of injury, HTS dosage, and rate of administration. Various HTS concentrations including 3%, 5%, 7.2%, 7.5%, and 20% were used. Modes of HTS administration included bolus (n = 125) and infusion (n = 376). Average length of stay was 22.4 days. Patient GCS score on initiation of HTS was depressed (average mean, 7.15; average median, 4.25 for studies reporting mean and median GCS, respectively). Excluding 2 studies with ambiguous doses, the mean HTS dosage was 2.7 × 10 mL across 8 studies and 2.5 mL/kg across 5 (with average post-HTS osmolality level of 304.6 mOsm/L reported in 3 studies). Infusions of 3% and 7.5% HTS are the most used concentrations given their efficacy in reducing intracranial pressure (ICP) and improving GCS score. In addition, lower HTS concentrations strongly correlated with greater ICP reduction. Therefore, lower concentrations of HTS may be practical therapeutic agents for patients with TBI given their efficacy in ICP reduction and safer complication profile compared with greater HTS concentrations. Evidence-based parametric use of HTS stands to improve patient outcomes by standardization of varied clinical practice.
高渗盐水（HTS）是治疗创伤性脑损伤（TBI）的常用辅助药物。然而，实践模式存在显著差异。为了实现 TBI 中 HTS 使用的最佳化和标准化，我们对神经外科学和神经危重病护理文献中报告的临床方案进行了全面审查。2021 年 10 月至 11 月期间，我们在 PubMed、Web of Science、Cochrane、Scopus 和 Embase 上独立查询。整个筛选过程都遵循 PRISMA 指南。我们确定了 15 项高质量研究，这些研究代表了 535 名患者的数据。我们提取了患者的人口统计学资料、格拉斯哥昏迷评分（GCS）、损伤机制、HTS 剂量和给药率。使用了各种 HTS 浓度，包括 3%、5%、7.2%、7.5%和 20%。HTS 给药方式包括推注（n=125）和输注（n=376）。平均住院时间为 22.4 天。开始使用 HTS 时患者的 GCS 评分较低（平均平均，7.15；平均中位数，4.25，分别为报告平均和中位数 GCS 的研究）。排除 2 项剂量不明确的研究后，8 项研究中 HTS 的平均剂量为 2.7×10 mL，5 项研究中为 2.5 mL/kg（3 项研究报告了平均 HTS 渗透压水平为 304.6 mOsm/L）。3%和 7.5%的 HTS 输注是最常用的浓度，因为它们在降低颅内压（ICP）和提高 GCS 评分方面有效。此外，较低的 HTS 浓度与更大的 ICP 降低强烈相关。因此，与较高的 HTS 浓度相比，较低浓度的 HTS 可能是 TBI 患者的实用治疗药物，因为它们在降低 ICP 和更安全的并发症方面具有疗效。基于证据的 HTS 参数使用有望通过标准化各种临床实践来改善患者的预后。
