From the Guidelines
According to the most recent and highest quality study, the use of a target serum sodium concentration of 145-155 mEq/L when administering hypertonic saline by peripheral continuous IV infusion to neurocritical care patients with cerebral edema provides a benefit in reducing elevated intracranial pressure, as evidenced by Qureshi and colleagues who targeted this sodium concentration range without reporting any adverse effects 1.
Key Points
- The target serum sodium concentration of 145-155 mEq/L is used to reduce elevated intracranial pressure in neurocritical care patients with cerebral edema.
- This approach creates an osmotic gradient that draws water from the brain tissue into the bloodstream, effectively reducing cerebral edema and lowering intracranial pressure.
- The continuous infusion method allows for more stable serum sodium levels compared to bolus administration, providing sustained ICP control.
- Careful monitoring of serum sodium levels is essential, with adjustments to the infusion rate as needed to maintain the target range.
- The goal is to achieve adequate cerebral decompression while avoiding complications from excessive or too rapid sodium elevation.
Benefits and Risks
- The benefit of using a target serum sodium concentration of 145-155 mEq/L is the reduction of elevated intracranial pressure, which is a critical aspect of managing cerebral edema.
- The risk of osmotic demyelination syndrome (ODS) is a concern with rapid or excessive sodium elevation, but studies have shown that this risk is minimized with careful monitoring and adjustment of the infusion rate 1.
- Other potential risks, such as phlebitis and extravasation, are also minimized with the use of peripheral continuous IV infusion.
Clinical Implications
- The use of a target serum sodium concentration of 145-155 mEq/L when administering hypertonic saline by peripheral continuous IV infusion is a viable option for reducing elevated intracranial pressure in neurocritical care patients with cerebral edema.
- Clinicians should carefully monitor serum sodium levels and adjust the infusion rate as needed to maintain the target range and minimize the risk of complications.
- Further studies are needed to fully elucidate the benefits and risks of this approach, but current evidence suggests that it is a safe and effective option for managing cerebral edema.
From the Research
Potential Benefits of Hypertonic Saline
The use of hypertonic saline (HTS) in neurocritical care patients with cerebral edema has been studied in various research papers. According to the studies, the potential benefits of using a target serum sodium concentration of 145-155 mEq/L when administering HTS by peripheral continuous intravenous (IV) infusion include:
- A short- and long-term benefit in reducing elevated intracranial pressure (ICP) 2, 3, 4
- A benefit in minimizing the risk for phlebitis and extravasation, as peripheral administration of HTS is likely safe in certain circumstances 5
- The studies do not provide direct evidence to support the use of a target serum sodium concentration of 145-155 mEq/L for mitigating the risk of adverse effects from prolonged hypernatremia or mitigating the risk of osmotic demyelination syndrome (ODS)
Administration and Safety
The administration of HTS by peripheral continuous IV infusion has been shown to be safe, with minimal adverse effects 2, 5. The use of HTS requires intensive efforts by the medical team to rapidly achieve and maintain a hypernatremic state 2. Proper protocols, education, and institutional safeguards are necessary to ensure the safe use of HTS 5.
Comparison with Other Treatments
The studies compare the use of HTS with other treatments, such as mannitol, and suggest that HTS may have a similar efficacy in reducing ICP 3, 4, 6. However, the optimal formulation, dosing, and administration of HTS are still unclear and require further research 5.