P. Fridrich, R. Härtl and W. Mauritz
Dept. of Anesthesia and Critical Care Medicine, Trauma Center „Lorenz Böhler“, Vienna, Austria
Introduction: Small-volume resuscitation with hypertonic saline or HHS
has been shown to result in less brain edema and lower ICP values than
resuscitation with conventional fluids (1,2,3). The goal of this prospective
study was to investigate the effects of HHS on ICP in patients with TBI.
Patients and Methods: 6 patients with TBI (GCS < 8, mean age 32
yrs) were enrolled. Standard treatment included ICP monitoring, mild hyperventilation
(pCO2 32-36 mmHg), administration of opioids, sedatives, and mannitol.
Patients received the study medication (NaCl 7.5% plus HES 6%, MW 200.000/0.06-0.66;
HYPERHESTM; Frese-nius Inc., Austria) if the entry criteria (ICP > 25 mmHg,
CPP < 70 mmHg, Na < 150 mmol/l, serum osmolality < 320 mOsm/l)
were met. HHS was infused at 20 ml/min until ICP < 25 mmHg and/or CPP
> 70 mmHg or a total dose of 250 ml were achieved. HR, ICP, CPP, Na+, K+,
Cl-, osmolality, and blood gases were recorded at baseline, 10 and 30 min
after HHS. If the entry criteria were met treatment was repeated after
a minimum interval of 4 hours.
Results: An average of 171 + 74 ml was infused per treatment. HR, Cl-,
and blood gases remained unchanged. Relevant results are given in the table;
significant changes (p < 0.05) are indicated by *:
| MAP | ICP | CPP | Na+ | K+ | Osmo | |
| Baseline | 97 | 45 | 52 | 143 | 4,0 | 300 |
| SD | 19 | 15 | 18 | 5,7 | 0,5 | 12 |
| 30 min | 97 | 25* | 72* | 144 | 4,0 | 304 |
| SD | 21 | 14 | 16 | 5,9 | 0,5 | 12 |
In patient who received repeated doses of HHS ICP reduction varied between
16 and 89% of baseline value. No side effects were observed.
Discussion: Infusion of HHS is now a standard procedure in fluid resuscitation
after trauma. The increases in Na+ and osmolality seen immediately after
infusion are transient and clinically not relevant. In other studies (4)
HHS have been shown to be more effective than mannitol in decreasing ICP.
HHS are the drug of choice for fluid resuscitation of trauma patients with
severe TBI.
References:
(1) Prough DS, et al. Crit Care Med 1985; 13:407-411
(2) Wisner DH, et al. J Trauma 1990; 30:75-78
(3) Zornow MH, et al. J Trauma 1989; 29:484-488
(4) Schwarz S, et al. Stroke 1998; 29:1550-1555