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Hypertonic saline (HS) has become increasingly popular as a treatment for brain edema and elevated intracranial pressure (ICP) in patients with severe brain injury. Global brain edema complicates many poor-grade cases of subarachnoid hemorrhage (SAH) and is associated with poor prognosis (Stroke 2002; 33:1225). Tseng and colleagues evaluated the effect of a single large bolus of 23.5% HS (2 mL/kg) on cerebral blood flow (CBF) in 10 patients with Hunt-Hess grade 4 or 5 SAH.
The results were impressive. Compared with baseline values, mean arterial pressure was increased by 11% and intracranial pressure was reduced by 75% after HS infusion, resulting in a 27% increase in cerebral perfusion pressure. Accordingly, CBF (as measured by xenon CT) in…