Hypertonic saline resuscitation for head injured patients.

OBJECTIVE To discuss the reasons why 250 ml 7.5% hypertonic saline was chosen as a pre-hospital resuscitation fluid for head injured patients in a multicentred, prospective, randomised controlled trial investigating its long term effects on central nervous system outcome. DATA SOURCES Recent published peer-review articles on the incidence and mechanisms of traumatic head injury and clinical use of hypertonic saline in pre-hospital resuscitation of trauma. SUMMARY OF REVIEW Head injury is commonly associated with major trauma and if hypotension also exists the morbidity and mortality due to cerebral injury are high. Hypertonic saline has been used in clinical practice to treat cerebral oedema and resuscitate burns patients following experimental evidence that it reduces tissue oedema, improves blood flow to damaged organs and may reduce the incidence of multiple organ dysfunction, when compared with resuscitation using isotonic solutions. In pre-hospital trauma patients, initial resuscitation using hypertonic saline rather than conventional isotonic solutions has the potential advantage of requiring a small volume of fluid that is easily stored and administered, and may improve cerebral circulation and reduce the long term neurological effects that are determined by pre-hospital hypovolaemia and hypotension. To answer the question whether hypertonic saline will improve the outcome in trauma patients with hypotension and head injury, a multicentred, randomised controlled trial comparing 250 ml of 7.5% hypertonic saline (320 mmol) with 250 ml of Hartmann's solution (32 mmol) in pre-hospital resuscitation of trauma patients with a Glasgow coma score < 9 and systolic blood pressure < 100 mmHg, began in 1998 and is anticipated to be completed by 2001. CONCLUSIONS Pre-hospital resuscitation of head injured and hypotensive trauma patients using hypertonic saline, has the potential to reduce long term cerebral injury and reduce social and financial costs to the community.