Therapeutic Uses Of Hypertonic Saline In The Critically Ill Emergency Department Patient (Trauma CME)
Hypertonic saline is defined as any crystalloid solution containing more than 0.9% saline. The administration of hypertonic saline has been studied alone as well as in combination with colloid solutions (most commonly dextran). Its many theoretical advantages (including small-volume resuscitation, reduction of intracranial pressure, improved hemodynamics, and improved microcirculation and immunomodulation) have prompted research into its use as a resuscitative fluid for a variety of critically ill patients. The 2 patient cohorts most frequently studied are patients with traumatic brain injury and trauma patients with hemorrhagic shock. Hypertonic saline has been shown to be safe and efficacious in decreasing intracranial pressure and improving hemodynamics with few adverse effects, but there are no prospective human trials demonstrating improved clinical outcomes for these patients. Hypertonic saline has been shown to be a valuable therapy for the treatment of severe hyponatremia in patients with signs of cerebral edema, but treatment guidelines are based mostly upon expert consensus and are not well defined. This review examines the evidence on the use of hypertonic saline for the treatment of patients with traumatic brain injury and secondary intracranial hypertension, trauma patients in hemorrhagic shock, and patients with severe hyponatremia.