Hypertonic Saline for Intracranial Hypertension

• Mannitol is commonly used to treat acute increases in intracranial pressure in patients with TBI, ICH, tumor, and CVA.
• While there is currently no conclusive evidence of superiority, a growing body of literature suggests hypertonic saline (HTS) may be more favorable than mannitol for acute increases in ICP.
• HTS is believed to work by:
  • osmotic effect
  • increasing cardiac output and MAP, thereby increasing cerebral oxygen delivery
  • improving microcirculatory flow
  • anti-inflammatory effects
• When administering HTS, concentrations ranging from 1.5% - 23.4% can be used, titrating to a serum Na concentration of 145-155 and a serum osm > 350 mOsm/L.

References

Torre-Healy A, Marko NF, Weil RJ. Hyperosmolar therapy for intracranial hypertension. Neurocrit Care 2011.