Why is hypertonic saline used

They excluded ICP crises confounded by external stimulation or mechanical ventilator adjustments were excluded. The authors analyzed doses of fentanyl, hypertonic saline , mannitol, and pentobarbital administered to 16 children median: 12 doses per patient.

They controlled for patients getting more than one of the meds and noted that ICP was decreased following hypertonic saline and pentobarbital administration; cerebral perfusion pressure was decreased following fentanyl and was increased following hypertonic saline administration. Hyperosmolar therapy in pediatric traumatic brain injury: a retrospective study. Pediatr Crit Care Med. About the Author: Brad Sobolewski.

All views are strictly my own and not official medical advice. Related Posts. September 1st, August 11th, May 12th, March 24th, March 10th, December 22nd, October 29th, June 23rd, June 9th, May 6th, It is difficult to classify hypertonic saline within this taxonomy because it has multiple mechanisms of action. Mucolytics disrupt the structure of the mucus gel, thereby reducing its viscosity and elasticity.

The intention of mucolytic therapy is therefore to make the viscoelasticity of the airway secretions better to facilitate their clearance from the airways. It has been suggested that hypertonic saline is not a mucolytic because mucolysis is not its primary mode of action. Another mucoactive class of medication is the expectorants, which add water to the airway surface. This is particularly relevant in the CF airway, because the abnormal or absent cystic fibrosis transmembrane conductance regulator CFTR protein does not initiate chloride ion secretion into the airway lumen and does not inhibit the absorption of sodium ions from the airway lumen via the epithelial sodium channel.

This also results in dehydrated airway secretions and disruption to the mucociliary mechanism. This allows the retention of mucus, which becomes a nidus for infection.

Another mucoactive class is the mucokinetics, which improve cough-mediated clearance by increasing airflow or reducing sputum adhesivity. We are unaware of any evidence that hypertonic saline has either of these immediate benefits, but it does trigger cough 14 and the cough increases the amount of mucus cleared from the lungs even further. The increase in mucociliary clearance with hypertonic saline and the extra clearance with cough have been objectively demonstrated in vivo in cystic fibrosis using radioaerosol studies.

Hypertonic saline may also have some other mechanisms that are not strictly mucoactive. Recent in vitro research has shown that hypertonic saline reduces biofilm formation by Pseudomonas aeruginosa and the production of associated virulence factors. An immediate benefit of the increase in mucus clearance is the opportunity to make a microbiological diagnosis in those patients who are unable to expectorate a sputum sample spontaneously. A single dose increases the chance of obtaining a sample in this population.

Riedler and colleagues 23 performed a cross-over trial in 10 adolescents with an exacerbation of their CF lung disease. On the following day, the alternate solution was inhaled prior to an identical physiotherapy session. Sputum was collected between the start of the inhalation and 60 min after the end of the physiotherapy regimen.

Two weeks after ceasing the inhalations, there was no significant difference in lung function. A benefit in lung function appears to be maintained with long-term use.

In a randomized trial in which adults and children with CF participated, the hypertonic saline group maintained significantly higher lung function across the week follow-up period. These benefits were accompanied by an improvement in several domains of quality of life. There was also close monitoring of sputum samples throughout the trial to check for any adverse effects on acquisition of organisms, organism density and inflammation.

Overall, these outcomes showed no detrimental effect of long-term use of the twice-daily regimen of hypertonic saline inhalations. An often overlooked benefit was that patients in the active arm of the study rated their ease of clearing sputum as significantly greater at the end of the trial. This probably has important social implications. If patients can clear their secretions more effectively at the time of airway clearance, it allows them to go about their work, study and social events with less concern about productive coughing during interactions with others.

No study has identified a subgroup of CF patients that responds particularly well to hypertonic saline therapy. For example, in the long-term trial, the effect of hypertonic saline on exacerbations did not differ significantly between users and non-users of physiotherapy, between subjects with mild or severe lung function impairment, nor between users and non-users of recombinant human deoxyribonuclease rhDNase.

We therefore recommend the therapy for most people with CF who find it tolerable. An interesting feature of much of the research discussed above is the presence of dose-response relationships for hypertonic saline. What are THEY being compared to? In nursing, we almost always compare solutions to something in the human body! So when we say that an IV solution is Hypertonic, what we are really saying is that the hypertonic fluid has a higher solute to solvent ratio than blood does.

Of all the IV solutions that nursing students have to study, Hypertonic IV solutions are probably the least used, and in my opinion can be the most confusing to understand. Arguably, they can also pose the highest risk of complications!

Notice that three of the hypertonic solutions listed above contain Dextrose, which is a sugar. The purpose of adding sugar is to provide extra calories to the patient.

The dextrose sugar is what makes these 3 solutions hypertonic: there is more solute per liter in the IV solution than there is in the blood. So you see that while dextrose solutions are technically hypertonic, they quickly leave the patient with only pure water or saline in the blood vessels, depending on which solution was used. At that point, these solutions behave functionally like either hypotonic or isotonic solutions. Think about it this way: if your blood is normally isotonic, then decreasing the amount of sodium ions in it will make it a bit hypotonic in comparison to what your blood SHOULD be.

This is because there are now fewer solutes sodium in the solvent blood. In order to get blood back to its normal isotonic state, we would want to add MORE solutes without adding much solvent. This strategy can help move blood levels back to their isotonic normal, thus correcting the hyponatremia.