Hypertonic Saline for Raised Intracranial Pressure Following Aneurysmal Subarachnoid Hemorrhage: A Systematic Review.

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Hypertonic Saline for Raised Intracranial Pressure Following Aneurysmal Subarachnoid Hemorrhage: A Systematic Review.

World Neurosurg. 2017 May 23;:

Authors: Pasarikovski CR, Alotaibi NM, Al-Mufti F, Macdonald RL

Abstract
BACKGROUND: The use of hyperosmolar agents such as mannitol or hypertonic saline (HTS) to control high intracranial pressure (ICP) in traumatic brain injury patients has been well studied. However, the role of HTS in the management of aneurysmal subarachnoid hemorrhage (aSAH)-associated raised ICP is still unclear.
METHODS: We performed a systematic review in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The primary outcome of this review is to quantify ICP reduction produced by HTS and its effect on clinical outcomes defined by any standardized functional score. Secondary outcomes included: HTS vs. mannitol in ICP reduction, HTS effects on cerebral vasospasm, and HTS dose concentration, infusion rate, infusion volume, frequency of re-dosing, and serum sodium/osmolality limits for repeat dosing.
RESULTS: Five studies were included in the review encompassing 175 patients. Studies on aSAH included mostly poor-grade patients (defined as World Federation of Neurosurgical Societies grade 4 and 5). HTS concentrations ranged from 3% to 23.5%. Most studies found that HTS decreased ICP when compared to either baseline or placebo. The mean decrease in ICP from HTS administration was 8.9 mm Hg [range: 3.3-12.1]. Only one study showed possible improvement in poor-grade aSAH outcomes.
CONCLUSIONS: The current evidence suggests that HTS is as effective as mannitol at reducing raised ICP in aSAH. However, there is not enough data to recommend the optimal and safest dose concentration or whether HTS significantly improves outcomes in aSAH.

PMID: 28549643 [PubMed - as supplied by publisher]

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