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Clearing the path: Hypertonic saline's impact on intracranial pressure in traumatic brain injury. A systematic review and meta-analysis.

Xiaoping Ren, Shuyan Liu, Ju Gao, Rupshikha Choudhury, Sanjay Rastogi

Advances in Clinical and Experimental Medicine · 2025-03-24 · Meta-analysis

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Abstract

OBJECTIVES: To assess the effectiveness of HTS in lowering elevated ICP in TBI patients with TBI. MATERIAL AND METHODS: A systematic search was conducted using 4 electronic databases (PubMed, Embase, Scopus, and Cochrane Library) to select relevant articles published in peer-reviewed journals. The risk ratio (RR) and mean difference (MD) were calculated, along with their 95% confidence intervals (95% CIs). Heterogeneity was assessed using Cochrane Q, I2 statistics and p-value. RevMan 5.4 was used. RESULTS: The current meta-analysis included 965 TBI patients from 15 randomized controlled trials (RCTs). We found that HTS was significantly more effective than other ICP-lowering agents with RR of 0.74 (95% CI: 0.58-0.94) for reduction of elevated ICP; RR = 0.57 (95% CI: 0.40-0.81) for all-cause mortality; RR = 0.68 (95% CI: 0.49-0.95) for rate of adverse hypernatremia; RR = 0.73 (95% CI: 0.60-0.88) for substantial change in the Glasgow Outcome Scale (GOS) score and shorter period of hospital stay with MD of -1.26 (95% CI: -2.30 to -0.21). CONCLUSION: We found that HTS is considerably effective in reducing elevated ICP with improvement in long-term neurological functions, all-cause mortality, rate of hypernatremia, and length of hospital stay in TBI patients.

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Tags

Fluids & blood · Hypertonic saline · Mortality & survival · Quality of life & function

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