Effect of a Hypertonic Lactated Ringerʼs Solution on Intracranial Pressure and Cerebral Water Content in a Model of Traumatic Brain Injury

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Abstract
There has recently been an increased interest in the use of hypertonic solutions for fluid resuscitation of trauma victims. In this study, we examined the acute cerebral effects of a hypertonic lactated Ringer''s solution (measured osmolality = 469 mOsm/Kg) in an animal model of traumatic brain injury. Following the production of a cerebral cryogenic lesion, eight New Zealand white rabbits were randomized to undergo hemodilution with either lactated Ringer''s (measured osmolality = 254 mOsm/kg) or hypertonic lactated Ringer''s. Over the course of the experiment the lactated Ringer''s group required significantly more fluid than the hypertonic group to maintain stable central venous and mean arterial pressure (245 .+-. 5 ml vs. 132 .+-. 20 ml; p < 0.0001). Osmolality increased in the hypertonic group by 13.5 .+-. 3.3 mOsm/kg whereas it decreased in the lactated Ringer''s group by 5.5 .+-. 2.6 mOsm/kg. Intracranial pressure increased in both groups over the course of the experiment but the increase in pressure was greater in the lactated Ringer''s group than the hypertonic group (9.5 .+-. 2.4 mm Hg vs. 1.7 .+-. 1.5 mm Hg; p< 0.001). Brain water content was significantly increased in the region of the lesion as assayed by both the wet/dry weight method and cortical specific gravity determinations, but there was no difference between the two treatment groups. Water content of the nonlesioned hemisphere was significantly less in the hypertonic group. This study suggests that hypertonic saline solutions may be useful for the resuscitation of hypovolemic patients with localized brain injury.