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Hypertonic Saline Not Better for TBI Resuscitation

Last Updated: October 05, 2010.

Initial resuscitation with hypertonic saline with or without dextran is not superior to normal saline resuscitation in non-hypovolemic patients with severe traumatic brain injury, according to research published in the Oct. 6 issue of the Journal of the American Medical Association.

TUESDAY, Oct. 5 (HealthDay News) -- Initial resuscitation with hypertonic saline with or without dextran is not superior to normal saline resuscitation in non-hypovolemic patients with severe traumatic brain injury (TBI), according to research published in the Oct. 6 issue of the Journal of the American Medical Association.

Eileen M. Bulger, M.D., of the University of Washington in Seattle, and colleagues conducted a randomized, placebo-controlled, double-blind multicenter trial to compare the efficacy of using a 250 mL bolus of 7.5 percent hypertonic saline solution (with or without dextran) compared to the same volume of 0.9 percent normal saline. Patients included in the trial all had severe TBI and were dichotomized by Extended Glasgow Outcome Scale scores of either greater than four or four or less.

At six months, the researchers found that there were no significant differences in the proportion of patients having severe neurologic outcomes between treatment groups (hypertonic saline/dextran versus normal saline: 53.7 versus 51.5 percent; hypertonic saline versus normal saline: 54.3 percent versus 51.5 percent; P = .67). At 28 days, survival was 74.3 percent with hypertonic saline/dextran, 75.7 percent with hypertonic saline, and 75.1 percent with normal saline (P = .88).

"While this does not preclude a benefit from such treatment were it administered differently, at present there appears to be no compelling reason to adopt a practice of hypertonic fluid resuscitation for TBI in the out-of-hospital setting," the authors conclude.

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