The Role of Hypertonic Saline Resuscitation in Traumatic Brain Injury Combined with Hemorrhagic Shock

Yonggang Peng

The University of Florida, Gainesville, USA

Wei Zhang

The Sixth People's Hospital of Shanghai Jiao Tong University School of Medicine, Shanghai, China

Siti Nurfatimah Mohd Shahpudin

sitinurfatimah.ms@usm.my

Department of Biomedical Sciences, Advanced Medical and Dental Institute, Universiti Sains Malaysia

Address correspondence to

Siti Nurfatimah Mohd Shahpudin, Department of Biomedical Sciences, Advanced Medical and Dental Institute, Universiti Sains Malaysia. Email:sitinurfatimah.ms@usm.my

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The Role of Hypertonic Saline Resuscitation in Traumatic Brain Injury Combined with Hemorrhagic Shock

Yonggang Peng

The University of Florida, Gainesville, USA

Wei Zhang

The Sixth People's Hospital of Shanghai Jiao Tong University School of Medicine, Shanghai, China

Siti Nurfatimah Mohd Shahpudin

sitinurfatimah.ms@usm.my

Department of Biomedical Sciences, Advanced Medical and Dental Institute, Universiti Sains Malaysia

Address correspondence to

Siti Nurfatimah Mohd Shahpudin, Department of Biomedical Sciences, Advanced Medical and Dental Institute, Universiti Sains Malaysia. Email:sitinurfatimah.ms@usm.my

2026 Mar;1(1):17-20

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Abstract

Objective: To explore the efficacy and safety of hypertonic saline (HS) resuscitation compared with normal saline (NS) in patients with traumatic brain injury (TBI) complicated by hemorrhagic shock. Methods: A prospective randomized controlled trial was conducted on 296 patients with moderate to severe TBI (Glasgow Coma Scale [GCS] 3–12) and hemorrhagic shock admitted to a Level 1 trauma center from June 2020 to August 2024. Patients were randomly assigned to the HS group (n=148, 7.5% hypertonic saline) and the NS group (n=148, 0.9% normal saline). The primary outcome measures included intracranial pressure (ICP) within 72 hours after resuscitation, cerebral perfusion pressure (CPP), and 28 day mortality. Secondary outcomes covered the incidence of acute lung injury (ALI), length of intensive care unit (ICU) stay, and 6 month Glasgow Outcome Scale (GOS) score. Results: The HS group exhibited significantly lower ICP levels (18.2 ± 3.5 mmHg vs. 23.5 ± 4.1 mmHg, P<0.001) and higher CPP values (72.3 ± 5.8 mmHg vs. 65.7 ± 6.2 mmHg, P<0.001) within 72 hours compared with the NS group. The 28 day mortality rate in the HS group was 16.2% (24/148), which was significantly lower than 27.0% (40/148) in the NS group (P<0.01). The incidence of ALI was comparable between the two groups (10.8% vs. 12.8%, P>0.05). The HS group had a shorter ICU stay (11.5 ± 2.7 days vs. 15.3 ± 3.2 days, P<0.001) and a higher proportion of favorable outcomes (GOS score 4–5) at 6 months (58.1% vs. 45.3%, P<0.05). Conclusion: Hypertonic saline resuscitation can effectively reduce ICP, improve CPP, decrease short term mortality, and enhance long term neurological outcomes in patients with TBI combined with hemorrhagic shock, without increasing the risk of ALI.

Keywords: Hypertonic saline; Traumatic brain injury; Hemorrhagic shock; Intracranial pressure; Cerebral perfusion pressure

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Journal of Contemporary Surgical Science

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Volume 1, Issue 1

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