Hypertonic saline (7.2%) in 6% hydroxyethyl starch reduces intracranial pressure and improves hemodynamics in a placebo-controlled study involving stable patients with subarachnoid hemorrhage

OBJECTIVE:To compare the effects of a bolus infusion of hypertonic saline hydroxyethyl starch with the effects of normal saline (placebo) on intracranial pressure (ICP) and cerebral perfusion pressure in patients with spontaneous subarachnoid hemorrhage. DESIGN AND SETTING:Prospective, randomized, single-blinded, placebo-controlled study in a university hospital. PATIENTS:A total of 22 mechanically ventilated patients with spontaneous subarachnoid hemorrhage with stable ICP between 10 and 20 mm Hg. INTERVENTIONS:During the course of 30 mins, 2 mL/kg of either 7.2% saline in 6% hydroxyethyl starch 200/0.5 (HSS) or of normal saline was infused. The effects were observed for another 180 mins. MEASUREMENTS AND MAIN RESULTS:Mean change in ICP after intervention (ΔICP) calculated from the average of all observations was −3.3 (sd 2.6) mm Hg in the HSS group vs. −0.3 (sd 1.3) mm Hg in the normal saline group. Mean difference between the groups (HSS − normal saline) was −3.0 mm Hg (95% confidence interval, −4.9 to −1.1; p = .004). Mean peak change after HSS was −5.6 (range, −0.8 to −12.2) mm Hg after 64 (range, 40 to 115) mins. Mean difference in cerebral perfusion pressure change between the groups (HSS − normal saline) was 5.4 mm Hg (95% confidence interval, 2.2 to 8.6; p = .002), and mean difference in cardiac index change, measured as the area under the curve for the whole study period, corresponded to 0.2 L·min·m (95% confidence interval, 0.03 to 0.4; p = .025). CONCLUSIONS:In this placebo-controlled study involving spontaneous subarachnoid hemorrhage patients with normal to moderately increased ICP, 2 mL/kg HSS reduced ICP and increased cerebral perfusion pressure significantly. Maximum effect was reached at twice the infusion time of 30 mins. There were also beneficial hemodynamic effects with increased cardiac index in the HSS group.