Clearing the path: Hypertonic saline's impact on intracranial pressure in traumatic brain injury. A systematic review and meta-analysis

Abstract

Background. Elevated intracranial pressure (ICP) significantly worsens neurological outcomes and mortality rates in patients with traumatic brain injury (TBI). Hypertonic saline (HTS), a hyperosmolar treatment, controls elevated ICP in TBI patients. However, there is still debate regarding the efficacy of HTS in managing TBI. Objectives. To assess the effectiveness of HTS in lowering elevated ICP in TBI patients with TBI. Materials and methods. A systematic search was conducted using 4 electronic databases (PubMed, Embase, Scopus, and Cochrane Library) to select relevant articles published in peer-reviewed journals. The risk ratio (RR) and mean difference (MD) were calculated, along with their 95% confidence intervals (95% CIs). Heterogeneity was assessed using Cochrane Q, I² statistics and p-value. RevMan 5.4 was used. Results. The current meta-analysis included 965 TBI patients from 15 randomized controlled trials (RCTs). We found that HTS was significantly more effective than other ICP-lowering agents with RR of 0.74 (95% CI: 0.58–0.94) for reduction of elevated ICP; RR = 0.57 (95% CI: 0.40–0.81) for all-cause mortality; RR = 0.68 (95% CI: 0.49–0.95) for rate of adverse hypernatremia; RR = 0.73 (95% CI: 0.60–0.88) for substantial change in the Glasgow Outcome Scale (GOS) score and shorter period of hospital stay with MD of –1.26 (95% CI: –2.30 to –0.21). Conclusions. We found that HTS is considerably effective in reducing elevated ICP with improvement in long-term neurological functions, all-cause mortality, rate of hypernatremia, and length of hospital stay in TBI patients.