Hypertonic saline for cerebral edema and elevated intracranial pressure

The use of HS solutions has been shown to reduce ICP both in animal models and in human studies in a variety of underlying disorders, even in cases refractory to treatment with hyperventilation and mannitol. There are several possible mechanisms of action, and important complications such as central pontine myelinolysis and intracranial hemorrhage have not been reported in the human studies. Different types of HS solutions with different methods of infusion (bolus and continuous) have been used in the past, and so far there are not enough data to recommend one concentration over another. Many issues remain to be clarified, including the exact mechanism of action of HS, the best mode of administration and HS concentration to be given, and the relative efficacy of HS vis-á-vis available treatments, particularly mannitol.