Comparison of intermittent versus continuous infusion of 3% hypertonic saline on intracranial pressure in traumatic brain injury using ultrasound assessment of optic nerve sheath

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Abstract

Background
The employment of hypertonic saline (HTS) in intracranial hypertension treatment has been effective when administered as a continuous infusion or bolus. However, the best route and concentration are undecided because of insufficient randomized controlled trials. This study aims to function the optic nerve sheath diameter (ONSD) ultrasonographic measurements to compare the effectiveness of 3% HTS continuous infusion and intermittent boluses in reducing elevated intracranial pressure (ICP) in traumatic brain injuries (TBIs).
Methods
This randomized study comprised 50 patients with TBI. In all patients examined by ultrasound, we employed a cutoff value of 5.5 mm for the ONSD to predict an increase in ICP of >20 mmHg. Patients with elevated ICP were divided into two groups: group A received continuous 3% HTS infusion (0.5 mL/kg/h), and group B received intermittent 3% HTS boluses (3 mL/kg). The primary endpoint was the ONSD at 48 h. The secondary outcomes included serum Na and serum K at 6, 12, 24, 48, and 72 h.
Results
The ONSDs in the continuous HTS infusion and intermittent bolus groups decreased significantly and steadily, with no significant variance between the two groups at 48 h (P = 0.449). However, 3% HTS intermittent boluses caused a faster growth in sodium concentration at 6 and 12 h with noteworthy differences compared with continuous infusion (P = 0.013 and 0.001, respectively).
Conclusions
There were no differences in ONSD ultrasonographic values 48 h after treatment. Moreover, 3% HTS intermittent boluses caused an increase in sodium concentration at 6 and 12 h.

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Egyptian Journal of Anaesthesia
Volume 38, Issue 1
December 2022
Pages 291-299

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