OBJECTIVE Describe outcomes associated with bolus and continuous infusions of hypertonic saline (HTS) in children with severe traumatic brain injury (TBI). METHODS IRB-approved, single-center, retrospective review of children admitted between January 1, 2012 to August 30, 2018 with a diagnosis of severe TBI who received HTS. RESULTS Forty-five children (age 9.3 ± 5.8 yr; 60% male) met inclusion criteria. One-hundred eighty-nine equiosmolar bolus doses of HTS were administered to 43 patients (3% HTS, n = 84 doses; 6% HTS, n = 38 doses; 12% HTS, n = 67 doses) for episodes of acute intracranial hypertension (pressure above 20 mmHg). Significant reductions in ICP were observed at 30, 60, and 120 min following HTS boluses with the greatest decrease observed in patients receiving 12%. Thirty-four patients received a continuous infusion of HTS. Higher concentrations of HTS were associated with a more favorable fluid balance (p < .001), fewer episodes of pulmonary edema (p = .003), and higher intake of protein and energy (p < .001). CONCLUSIONS Equiosmolar bolus doses of concentrated HTS were associated with significant reductions in ICP. Benefits of higher concentrations of continuous HTS may include improved fluid balance, less pulmonary edema, and greater amounts of protein and energy intake.

中文翻译：

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浓缩高渗盐水治疗严重的小儿脑外伤。

目的描述重度脑外伤（TBI）儿童与推注和持续输注高渗盐水（HTS）相关的结局。方法对2012年1月1日至2018年8月30日之间入院，诊断为接受HTS的严重TBI的儿童进行IRB批准的单中心回顾性研究。结果45名儿童（9.3±5.8岁；男性60％）符合纳入标准。对急性颅内高压发作的43例患者（139％HTS，n = 84剂； 6％HTS，n = 38剂； 12％HTS，n = 67剂）给予一百八十九等渗剂量的HTS （压力高于20 mmHg）。HTS推注后30、60和120分钟观察到ICP显着降低，接受12％的患者观察到最大的降低。34名患者接受了HTS的连续输注。较高的HTS浓度与更有利的体液平衡（p <.001），较少的肺水肿发作（p = .003）和较高的蛋白质和能量摄入（p <.001）有关。结论浓缩HTS的等渗推注剂量与ICP的显着降低有关。较高浓度的连续HTS的好处可能包括改善体液平衡，减少肺水肿以及增加蛋白质和能量的摄入量。