Hypertonic saline in ICU setting: what is its position? A systematic review and empirical analysis

Abstract Background Fluid overload has been linked to poor outcomes in the critically ill in recent years, with multiple studies showing an increase in mortality in the overall intensive care unit population. Although the administration of hypertonic saline has increased in recent years, few publications involving its use in intensive care unit have been published to date. The aim of this systematic review is to compare hypertonic and isotonic saline solutions and assess the current evidence to determine whether hypertonic saline can be used in the intensive care unit to treat critically ill or injured patients. Main body The PRISMA protocol was applied to conduct the search, which generated 622 possible trials. Only four papers were chosen and included in our study after duplicates and studies that did not fulfill our inclusion criteria, and outcomes were removed. The primary outcome was mortality, with the length of time spent in intensive care and in the hospital as secondary outcomes, and patients assessed in the intensive care unit ranged from 3 to 55, according to our revision. There were three to 24 trials in all, and not all of them used mortality or intensive care unit stay as an endpoint. The concentration of HS used in the intervention group ranged from 1.4 to 30%, while not all studies used isotonic saline solution as a control group. Conclusions Despite the limited scientific evidence, there seems to be support for the administration/use of hypertonic saline in the intensive care unit setting, in highly selected circumstance. Although hypertonic saline may have favorable therapeutic effects, no effect on mortality has been demonstrated. Patients suffering from a traumatic brain injury evidence suggests that hypertonic saline can effectively lower intracranial pressure, and there is a new trend supporting the use of hypertonic sodium solutions in these situations. Our updated review shows that studies still have a lot of variability, and that more controlled research are needed.