Hypertonic saline usage in traumatic brain injury: A focus on pediatrics

In this chapter, we outline the use of hypertonic saline in children (18years old or younger) with traumatic brain injury. We begin with an overview of the use of hyperosmolar therapy in traumatic brain injury followed by the history and evolution of hypertonic saline in the clinical setting. We then briefly review the pathophysiology of traumatic brain injury and the proposed mechanisms by which hypertonic saline affects the injury in children. We then discuss the more clinical aspects of hypertonic saline—this includes the various available concentrations of hypertonic saline as well as the practicalities of using hypertonic saline, such as the indications of use, recommended monitoring, and potential adverse effects. Finally, we end with highlighting the evidence behind the use of hypertonic saline in children.