Hypertonic solutions in traumatic brain injury: A systematic review and meta-analysis

Nida Fatima; Ali Ayyad; Ashfaq Shuaib; Maher Saqqur

doi:10.4103/ajns.AJNS_8_19

Asian Journal of Neurosurgery, Table of Contents

CC BY-NC-ND 4.0 · Asian J Neurosurg 2019; 14(02): 382-391
DOI: 10.4103/ajns.AJNS_8_19

Review Article

Hypertonic solutions in traumatic brain injury: A systematic review and meta-analysis

Nida Fatima

Department of Neurosurgery, Hamad General Hospital, Doha

,

Ali Ayyad

Department of Neurosurgery, Hamad General Hospital, Doha

,

Ashfaq Shuaib

¹Department of Neuroscience, Hamad General Hospital, Doha, Qatar

²Department of Neurology, University of Alberta, Edmonton, Alberta, Canada

,

Maher Saqqur

¹Department of Neuroscience, Hamad General Hospital, Doha, Qatar

²Department of Neurology, University of Alberta, Edmonton, Alberta, Canada

› Author Affiliations

Abstract

This study aims to evaluate the efficacy of hypertonic saline versus crystalloids (normal Saline/lactated Ringers) in improving clinical outcome in patients with traumatic brain injury (TBI). Electronic databases and grey literature (unpublished articles) were searched under different MeSH terms from 1990 to present. Randomized control trials, case–control studies and prospective cohort studies on decompressive craniectomy in TBI (>18-year-old). Clinical outcome measures included Glasgow Coma Outcome Scale (GCOS), Extended GCOS, and mortality. Data were extracted to Review Manager Software. A total of 115 articles that met the inclusion criteria were retrieved and analyzed. Ultimately, five studies were included in our meta-analysis, which revealed that patients with TBI who had hypertonic saline had no statistically significant likelihood of having a good outcome at discharge or 6 months than those who had crystalloid (odds ratio [OR]: 0.01; 95% confidence interval (CI): 0.03–0.05; P = 0.65). The relative risk (RR) of mortality in hypertonic saline versus the crystalloid at discharge or 6-month is RR: 0.80; 95% CI: 0.64–0.99; P = 0.04. The subgroup analysis showed that the group who had hypertonic solution significantly decreases the number of interventions versus the crystalloid group OR: 0.53; 95% CI: 0.48–0.59; P < 0.00001 and also reduces the length of intensive care unit stay (OR: 0.46; 95% CI: 0.21–1.01; P = 0.05). Hypertonic saline decreases the financial burden, but neither impacts the clinical outcome nor reduces the mortality. However, further clinical trials are required to prove if hypertonic saline has any role in improving the clinical and neurological status of patients with TBI versus the normal saline/lactated Ringers.

Key-words:

Clinical outcome - hypertonic saline - traumatic brain injury

Full Text

References

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