Roquilly A, Mahe PJ, Demeure Dit Latte D, Loutrel O, Champin P, Di Falco C, Courbe A, Buffenoir K, Hamel O, Lejus C, Sebille V, Asehnoune K.; Crit Care. 2011 Oct 28;15(5):R260. [Epub ahead of print]
INTRODUCTION: Description of a continuous hypertonic saline solution (HSS) infusion using a dose-adaptation of natremia in traumatic brain injured (TBI) patients with refractory intracranial hypertension (ICH).
METHODS: Single-centre retrospective study in a Surgical Intensive Care Unit of a tertiary hospital. Fifty consecutive TBI patients with refractory ICH treated with continuous HSS infusion adapted to a target of natremia. Briefly, a physician set a target of natremia adapted to the evolution of intracranial pressure (ICP). Flow of NaCl 20% was a priori calculated according to natriuresis, current and target natremia that were assessed every four hours.
RESULTS: The HSS infusion was initiated for a duration of 7 (5-10) [8+/-4] days. ICP decreased from 29 (26-34) [31+/-9] mmHg at H0 to 20 (15-26) [21+/-8] mmHg at H1 (P < 0.05). Cerebral perfusion pressure increased from 61 (50-70) [61+/-13] mmHg at H0 up to 67 (60-79) [69+/-12] mmHg at H1 (P < 0.05). No rebound of ICH was reported after stopping continuous HSS infusion. Natremia increased from 140 (138-143) [140+/-4] at H0 up to 144 (141-148) [144+/-4] mmol.l-1 at H4 (P < 0.05). Plasma osmolarity increased from 275 (268-281) [279+/-17] mmol.l-1 at H0 up to 290 (284-307) [297+/-17] mmol.l-1 at H24 (P < 0.05). The main side effect observed was an increase in chloremia from 111 (107-119) [113+/-8] mmol.l-1 at H0 up to 121 (117-124) [121+/-6] mmol.l-1 at H24 (P < 0.05). Neither acute kidney injury nor pontine myelinolyse were recorded.
CONCLUSIONS: Continuous HSS infusion adapted to close biological monitoring enables long-lasting control of natremia in TBI patients along with a decreased ICP without any rebound on infusion discontinuation.
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