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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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