P0033 / #1954: THE EFFECT OF HYPERTONIC SALINE ON INCREASED INTRACRANIAL PRESSURE IN TRAUMATIC BRAIN INJURY: PROSPECTIVE STUDY WITH NON-INVASIVE METHOD

Abstract

Aims & Objectives: Transcranial Doppler (TCD) ultrasound examination is a noninvasive method for determination of intracranial pressure. The main goal of this study was to show the effectiveness of hypertonic salin infusions in reducing intracranial pressure (ICP) by using TCD ultrasound. Methods: We included all patients with mild to severe traumatic brain injury (TBI) in our intensive care unit. TCD ultrasound examinations were performed by intensivists before and after hypertonic salin infusions. We used the pulsatility index (PI) of both middle cerebral artery and optic nerve sheet diameter (ONSD) and applied the ICP equations. Results: Seventeen patients with mild to severe TBI and 12 patients in control group were included. All measurements on the TBI patients performed after a first hypertonic salin as a salvage therapy in the emergency room. The median GCSs of the patients at admission and discharge were 10 and 15 respectively. There was a significant decrease in PI after the 3rd measurement in post-hoc multiple comparisons (p=0.004). On the other hand, it was found that the decrease in ONSD became evident after the 5th measurement (p<0.0001). Eight of 17 had axonal injury findings in MRI. Two of the patients had decompressive craniectomy and none of them had died. Conclusions: The repeated hypertonic salin infusions reduce the ICP in traumatic brain injury in children and related improved GCSs. Calculation of ICP using PI and ONSD measured via TCD is a safe and fast method to determine the ICP noninvasively.