| Wade CE et al, 1997, Sweden | 223 patients with severe head injuries and hypotension. 250 ml 7.5% NaCl/6% Dextran 70 (single bolus) v standard care (usually Ringer’s lactate) | Cohort analysis from six previous PRCTs | 24 hour survival | Odds ratio of 1.92 (p = 0.06) for survival 24 hours with HS | Heterogeneous trials, which were not all designed to assess head injured patients |
| | | Discharge Survival | Odds ratio of 2.12 (p = 0.048) for survival until discharge with HS | Long term outcome not assessed |
| Shackford SR et al, 1998, USA | 34 patients with severe head injuries and undergoing ICP monitoring. 1.6% NaCl (HS) v Ringer’s lactate (RL) to treat “episodes of haemodynamic instability” during initial resuscitation and for 5 days | PRCT | ICP | No significant difference between groups. Maximum ICP fell 9.1 mm Hg with HS and rose 2.5 mm Hg with RL (p<0.05) | CPP not addressed |
| | | Number of interventions to control increased ICP | Average of 31 interventions per patient with HS v 11 interventions with RL (p<0.01) | HS group had more severe injuries |
| | | Glasgow Outcome Score at discharge | No significant difference | Small numbers: a power study indicated the need for 320 patients but only 34 were enrolled |
| Simma B et al, 1998, Switzerland | 32 children with severe head injury and ICP monitoring. 1.6% NaCl (HS) v Ringer’s lactate (RL) as only IV fluid for 3 days following injury. | PRCT | ICP and CPP Number of interventions to control increased ICP | No significant difference Average of 44 interventions per patient with HS v 62 per patient with RL. (p<0.02) | Small numbers: the power calculation was directed towards detecting a difference in ICP |
| | | Na concentration and ICP | Inverse correlation (p<0.3) in both groups | |
| | | Na concentration and CPP | Inverse correlation significant only in HS group after 8 hours (p = 0.002) otherwise N/S | |
| | | Length of ICU stay | Shorter ICU stay: 11.6 v 8.0 days (p = 0.04) | Increase in ICP treated by stepwise increase therapy, thus not surprising that no difference in ICP seen |
| | | Complications | Higher incidence in RL group (N/S) | |
| | | Ventilation times | Longer duration in RL group (N/S) | |
| | | Length of hospital stay | No significant difference | |
| | | Survival | No significant difference | |