(636) Getting Salty: Infusion vs Bolus Dosing of Hypertonic Saline in Patients With Traumatic Brain Injury

Monday, January 22, 2024

2:30 PM – 3:30 PM MT

Location: Connections Central - RST 17

First Author(s)

MD

Mitchell J. Daley, BCCCP, PharmD, FCCM

Clinical Pharmacist Specialist Critical Care
Seton Family Healthcare, University of Texas
Austin

Co-Author(s)

EC

Emily Cox, PharmD

PGY2 Pharmacy Resident
Dell Seton Medical Center at the University of Texas, United States
JS

John Schroeder, PharmD

PhD Candidate
University of Texas, United States
EH

Emily Hodge, PharmD

Clinical Pharmacy Specialist
University Hospital, United States
VA

Victoria Acosta, ANP

Nurse Practioner Supervisor
Dell Seton Medical Center at the University of Texas, United States
JC

Josh Crapps, MD

SICU Fellow
Dell Medical School, University of Texas, United States
MM

Marissa Mery, MD

Assistant Professor
Dell Medical School, University of Texas, United States
TC

Tatiana Cardenas, MD, MPH

Assistant Professor
Dell Medical School, University of Texas, United States
MT

Marc Trust, MD

Assistant Professor
Dell Medical School, University of Texas, United States
JA

Jayson Aydelotte, MD

Associate Professor
Dell Medical School, University of Texas, United States
JD

Joseph DuBose, MD

Professor
Dell Medical School, University of Texas, United States
CB

Carlos Brown, MD

Physician
University of Texas at Austin Dell Medical School, United States

Introduction: Hypertonic saline (HTS) is a mainstay of treatment for patients with traumatic brain injury (TBI), both to alleviate elevated intracranial pressure (ICP) and maintain serum sodium concentrations. Yet, there is currently little evidence on the ideal method to administer HTS. The purpose of this study is to compare the efficacy and safety of 3% HTS bolus dose (BD) vs. continuous infusion (CI) to achieve goal sodium concentrations amongst patients with TBI. We hypothesize that BD of 3% HTS will lead to faster goal serum sodium levels without an increase in adverse events.

Methods: This was a single center, retrospective, cohort study conducted in patients 15 years of age or older admitted to the intensive care unit (ICU) with a diagnosis of TBI and who received BD or CI 3% HTS between January 2018 and November 2022. The study institution transitioned from CI to BD HTS in April 2022. The primary outcome was time to goal serum sodium and secondary outcomes included performance metrics at 72 hours (e.g. percent of sodium concentrations at goal, total volume of HTS), efficacy outcomes (e.g. delayed neurosurgical procedure, ICU length of stay, Glasgow Coma Scale (GCS) at discharge, in-hospital all-cause mortality) and safety outcomes (e.g. central line placement, metabolic derangements, sodium overcorrection, acute kidney injury).

Results: A total of 90 patients were included (BD n=45, CI n=45). Patients receiving BD HTS achieved goal sodium quicker than patients who received a CI [2.55 hours (IQR, 0 to 14.67) vs. 14.79 hours (IQR, 8.96 to 23.28); p< 0.01]. Patients in the BD required less volume of 3% HTS at 72 hours [750 mL (IQR, 250 to 1750) vs. 2493 mL (IQR, 1642.34 to 3312.83); p< 0.01] and required less central line placement [44.44% vs. 100%; p< 0.01]. There was no difference in percentage of sodium levels at goal for 72 hours [83.3% (IQR 61 to 92) vs. 56% (IQR 44 to 83); p=0.09], ICU length of stay [12 (IQR 6 to 17) vs. 10 (IQR 7 to 17); p=0.93], GCS at discharge [14 (IQR 8 to 15) vs. 14 (IQR 6 to 15); p=0.57], mortality (20% vs. 24.4%; p=0.61) or any other safety outcome investigated.

Conclusions: Amongst patients with TBI admitted to the ICU, BD 3% HTS is associated with shorter time to achieve goal sodium levels, less volume of HTS, fewer central lines, and a similar safety profile.