I had always thought that the debate around HS was settled, but there was a recent systemic review in the CMAJ 2016, that did not find it to be beneficial when compared to other mechanisms.

https://www.cambridge.org/core/journals/canadian-journal-of-emergency-medicine/article/hypertonic-saline-in-severe-traumatic-brain-injury-a-systematic-review-and-metaanalysis-of-randomized-controlled-trials/C3FB8AA0FE865B173423F6933A293835 <https://www.cambridge.org/core/journals/canadian-journal-of-emergency-medicine/article/hypertonic-saline-in-severe-traumatic-brain-injury-a-systematic-review-and-metaanalysis-of-randomized-controlled-trials/C3FB8AA0FE865B173423F6933A293835>

There is good discussion of this on SGEM:

http://thesgem.com/2016/03/sgem150-hypertonic-saline-for-traumatic-brain-injury/ <http://thesgem.com/2016/03/sgem150-hypertonic-saline-for-traumatic-brain-injury/>

I contrast these to the article below which actually did find HS was better.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4665128/ <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4665128/>

That said…I go for it before I would use mannitol.  But it’s an interesting debate and am curious to hear what others are doing?
Mike Falk
NY, NY.

P.S.  I am adding Cochrane review of Mannitol.

http://www.cochrane.org/CD001049/INJ_mannitol-for-acute-traumatic-brain-injury



> On Aug 1, 2017, at 3:57 PM, Tom Ruffin Jr <[log in to unmask]> wrote:
> 
> Recently the Neurosurgery department at our hospital has questioned the use of 3% hypertonic saline given in the ED for traumatic brain injury when clinically indicated. 
> 
> They site a lack of great data supporting improved mortality when given in the ED. 
> 
> To me there are not enough studies, looking at both mortality and morbidity, to not give it a shot in these critically injured kids. 
> 
> Despite the lack of great evidence I wanted to see what is being done around the country.
> 
> 1- Do you know of additional studies citing the use of 3% HTS in TBI. 
> 
> 2- Is anyone still using Mannitol?
> 
> 3- Do you have a protocol in place for when to use 3% HTS in TBI. 
> 
> 4- If a protocol is in place, who is involved?(Neurosurgery, critical care, etc)
> 
> Thanks for your input!
> 
> Tom Ruffin 
> For more information, send mail to [log in to unmask] with the message: info PED-EM-L
> The URL for the PED-EM-L Web Page is:
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