(569) Evaluation of Hypertonic Saline Dosing for Preventing Hemicraniectomy After Large Ischemic Stroke

Introduction: Although utilization of hypertonic saline (HTS) in managing cerebral edema in patients with acute ischemic stroke is widely accepted, optimal dosing strategies have not been established in current guidelines. The purpose of this study was to assess the relationship between HTS dosing strategies and the subsequent requirement for hemicraniectomy. It was hypothesized that higher doses of HTS will lead to decreased requirement for hemicraniectomy.

Methods: This was a retrospective, single center, case-control study of patients receiving HTS after acute ischemic stroke. Patients were included if they experienced an acute ischemic stroke and received HTS during index admission. Patients were excluded if they received HTS for any other indication. Statistical analysis was conducted using Chi-square test or Fishers exact test. The primary outcome was to assess the impact of the total and weight-based HTS dose received on requirement for hemicraniectomy. The secondary outcome was to assess the effect of time to HTS initiation from stroke onset on subsequent need for hemicraniectomy.

Results: Seventy-five patients were included in this study, of which 16 underwent hemicraniectomy and 59 did not. The mean National Institutes of Health Stroke Scale score on arrival was 18.5 for both groups. The mean age was significantly lower in patients who received a hemicraniectomy than those who did not, 49.7 years and 60.4 years, respectively (p=0.022). A mean total of 3808.3 mOsmol and 2429.5 mOsmol was administered, respectively (p=0.161), corresponding to 47.9 mOsmol/kg and 27.9 mOsmol/kg (p=0.177). There was no significant difference in mean time to initiation of HTS from stroke onset (24.6 hrs vs 31 hrs, p=0.355). There was no difference in mortality (38% vs 37%, p=0.988).

Conclusions: There was no significant association between HTS dose received or time to HTS initiation and requirement for hemicraniectomy in patients with acute ischemic stroke. These findings are interesting when considering that patients requiring hemicraniectomy were significantly younger and numerically received earlier, larger HTS doses than those who did not.