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Thu Apr 27 18:09:12 BST 2006

Hey Ron,

  Sorry to butt into the conversation, but have you tried Jose Suarez's review article? I believe it states the benefits of HTS quite nicely in TBI with cerebral edema; even in cases where PT also had intracranial and subarachnoid hemorrhage. Perhaps it could be of some use?

  Suarez, J. Hypertonic Saline for Cerebral Edema and Elevated Intracranial Pressure. Cleveland Clinic Journal of Medicine. 2004. Vol 71:Sup1, pg.S13.

  I think you may be able to find it by doing a search on the CCJM site. I believe I can also provide you with the PDF if you'd like. 

  -Mike F 

Ronald Gross <Rgross at harthosp.org> wrote:
  Hi Steve,

Been there, done that. I am looking for that one paper that PROVES
that HTS improves outcome in the severe TBI patient with Cerebral
edema.......

Ron

>>> 04/27 7:27 AM >>>
Ron,

The IOM report is a good place to start although not specifically
directed at TBI. It is getting a bit dated at this point.

Steve Smith 

-----Original Message-----
From: Ronald Gross 
To: trauma-list at trauma.org 
Sent: Thu, 27 Apr 2006 07:21:26 -0400
Subject: Re: Hypertonic saline

Folks,
Can you provide me with the best reference (in your opinion) for the
use of HTS in the treatment of TBI/cerebral edema? 
Thanks,
Ron

>>> "Ian Seppelt" 04/26 9:58 PM >>>
In ICU we use hypertonic saline as osmotic treatment of choice for
intracranial hyertension. Some recalicitrant neurosurgeons still want
to
use mannitol and I haven't yet convinced the emergency dept to change
completely. The pre hospital (physician based) retrieval service here
just carries hypertonic saline [pragmatic reason for abandoning
mannitol
was the fact that it turned to jelly in cold temperatures].

Note I am just referring to emergency management of intracranial
hypertension. Jamie Cooper demonstrated no difference in outcome with
the routine use of hypertonic saline for TBI prehospital (JAMA 2004,
291:1350-1357)

Cheers, Ian

Ian Seppelt FANZCA FJFICM
Senior Staff Specialist
Dept of Intensive Care Medicine
The Nepean Hospital, PO Box 63 Penrith NSW 2751
Clinical Lecturer, University of Sydney

>>> glamourcv at gmail.com 24/04/2006 3:16pm >>>
Dear everybody

I would like to make a simple query at this website...

How many of you follow regular hypertonic saline resuscitation
protocols for hemorrhagic shock?

How many of you use hypertonic saline as first line therapy for head
trauma with brain edema?

How many of you follow regular hypertonic saline resuscitation
protocols for septic shock resuscitation?

I am expecting your answers.

Thanks in advance,

claudia
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