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Fri Apr 28 06:27:20 BST 2006

Hi, Ron,

you know the study below?
If you need a nearly complete list of references for HS please contact
me off list.

J Trauma. 1997 May;42(5 Suppl):S61-5.
Individual patient cohort analysis of the efficacy of hypertonic
saline/dextran in patients with traumatic brain injury and hypotension.
Wade CE, Grady JJ, Kramer GC, Younes RN, Gehlsen K, Holcroft JW.

Medisan Pharmaceuticals Inc., Uppsala, Sweden.

BACKGROUND: Resuscitation with hypertonic saline/dextran (HSD) has been
suggested to be efficacious in patients who have traumatic brain injury
and are hypotensive. We undertook a cohort analysis of individual
patient data from previous prospective randomized double-blinded trials
to evaluate improvements in survival at 24 hours and discharge after
initial treatment with HSD in patients who had traumatic brain injury
(head region Abbreviated Injury Score > or = 4) and hypotension
(systolic blood pressure < or = 90 mm Hg). METHODS: All variables and
end points were defined before initiation of data handling.
Investigators were blind as to the treatment. Case report forms were
received from six studies. Of these, 223 patients met the inclusion for
traumatic brain injury. Comparisons between HSD and standard of care
were made using stratified analysis and logistic regression to assess
efficacy, confounding, and interaction. Potential confounding variables
of pre-fluid treatment, Glasgow Coma Scale score (3-8 vs. 9-15), injury
type, and systolic blood pressure can be considered a priori factors
that were known before randomization. Effects of the various trials was
also considered. RESULTS: Treatment with HSD resulted in a survival
until discharge of 37.9% (39 of 103) compared with 26.9% (32 of 119)
with standard of care (p = 0.080). Using logistic regression, adjusting
for trial and potential confounding variables, the treatment effect can
be summarized by the odds ratio of 2.12 (p = 0.048) for survival until
discharge. CONCLUSIONS: Patients who have traumatic brain injuries in
the presence of hypotension and receive HSD are about twice as likely to
survive as those who receive standard of care.

Walter Mauritz MD PhD
Professor of Anesthesia and Critical Care Medicine
Trauma Hospital "Lorenz Boehler"
A - 1200 Vienna, AUSTRIA, EU
phone: ++43 1 33110 789
fax: ++43 1 33110 277
e-mail: walter.mauritz at auva.at

-----Original Message-----
From: trauma-list-bounces at trauma.org
[mailto:trauma-list-bounces at trauma.org] On Behalf Of Ronald Gross
Sent: Thursday, April 27, 2006 1:30 PM
To: trauma-list at trauma.org
Subject: Re: Hypertonic saline

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

>>> <flysurg at aol.com> 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 <Rgross at harthosp.org>
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" <SeppelI at wahs.nsw.gov.au> 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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