Administration of 3% Hypertonic Saline for Intracranial Pressure Reduction

Dosing Strategies

The American College of Cardiology is not mentioned, however, the guideline recommends administering 3% hypertonic saline as a continuous infusion targeting serum sodium of 145-155 mmol/L, or as bolus doses of 5.3 mL/kg infused over 15-20 minutes for acute ICP elevation, with a strength of evidence of Grade B 1
Continuous infusion of 3% hypertonic saline is particularly validated in pediatric traumatic brain injury with mean treatment duration of 7.6 days, and is commonly used in children with TBI, with a moderate level of evidence 1

Infuse 3% hypertonic saline over 15-20 minutes for bolus therapy to treat threatened intracranial hypertension or signs of brain herniation, with a high level of evidence 1
The effect of 3% hypertonic saline lasts 2-4 hours with maximum effect observed at 10-15 minutes, with a moderate level of evidence 1

Measure serum sodium within 6 hours of bolus administration, and do not re-administer until serum sodium is <155 mmol/L, with a high level of evidence 1
Target range is 145-155 mmol/L; avoid exceeding 155-160 mmol/L to prevent complications, with a moderate level of evidence 1

3% hypertonic saline is effective in traumatic brain injury, subarachnoid hemorrhage, intracerebral hemorrhage, and acute liver failure, with a moderate level of evidence 1
Can be used in both adult and pediatric populations, with a high level of evidence 1

Not recommended for volume resuscitation in hemorrhagic shock unless combined with severe head trauma and focal neurological signs, with a moderate level of evidence 1
Avoid rapid or excessive sodium correction to prevent osmotic demyelination syndrome, with a high level of evidence 1

Despite effectiveness in reducing ICP, there is no evidence that hypertonic saline improves neurological outcomes (Grade B) or survival (Grade A) in patients with raised intracranial pressure, with a high level of evidence 1
No evidence of osmotic demyelination syndrome has been reported with proper monitoring, even with sustained hypernatremia, with a moderate level of evidence 1
Monitor fluid, sodium, and chloride balances to prevent hypernatremia and hyperchloremia complications, with a high level of evidence 1