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.
There is good discussion of this on SGEM:
I contrast these to the article below which actually did find HS was better.
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?
P.S. I am adding Cochrane review of Mannitol.
> 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
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