Objective: Pediatric traumatic brain injury
is a major public health problem in the United States. Hypertonic saline
therapy is a well-established treatment in patients with severe traumatic brain injury
(Glasgow Coma Scale ≤ 8) who have intracranial hypertension. In children, fluid overload
is associated with increased mortality, ventilator duration, and length of PICU stay, even when controlling for severity of illness. This study reports prevalence of fluid overload
patients with severe traumatic brain injury
treated with 3% hypertonic saline
and effect on clinical outcomes.
Single-center retrospective chart review.
PICUs at two tertiary children’s hospitals.
One hundred thirty-eight patients with traumatic brain injury
with postresuscitation Glasgow Coma Scale less than or equal to 8 who received hypertonic saline
from September 1, 2010, to February 28, 2016, and intracranial pressure monitoring and survived at least 24 hours from admission.
Measurements and Main Results:
We used fluid balance percentage greater than or equal to 10% as our definition of fluid overload
. Ninety-one percent of patients less than 1 year old had fluid overload
on day 10 of admission compared with 47% of patients greater than 1 year. Fluid overloaded patients did not have increased mortality, acute kidney injury, PICU length of stay, or ventilator days. Hypertonic saline
was not the cause of fluid overload
in these patients.
Patients with severe traumatic brain injury
do have high rates of fluid overload
. However, fluid overload
did not contribute to mortality, longer days on the ventilator, increased risk of acute kidney injury, or increased PICU length of stay.