Research and Reviews in the Fast Lane (which is a must for anyone consuming FOAM) just covered a SR and meta-analysis on hypertonic saline. Relevant after our discussion in conference this morning.

Berger-Pelleiter E, et al. Hypertonic saline in severe traumatic brain injury: a systematic review and meta-analysis of randomized controlled trials. CJEM 2016. PMID: 26988719

• Hypertonic saline seems to be recommended more and more often for intracranial hypertension. What is the evidence in traumatic brain injury?
  This is a systematic review and meta-analysis that identified 11 RCTs covering 1820 adult patients with traumatic brain injury comparing hypertonic saline to either mannitol (½ the studies) or another solution (often normal saline, or even hypotonic saline.) Hypertonic saline did not decrease mortality (RR 0.96, 95%CI 0.83-1.11). It didn’t lower intracranial pressure (weighted mean difference -0.39, 95%CI -3.78 – 2.99). And it didn’t improve functional outcomes (RR 1.12, 95% CI 0.92-1.36). Maybe we shouldn’t be rushing to adopt hypertonic saline in the management of traumatic brain injury.

• Recommended by Justin Morgenstern