A LOOK AT THE PROSPECTS OF MEDICAL USE OF HYPERTONIC SODIUM CHLORIDE SOLUTION IN THE HEALTHCARE SYSTEM OF THE ARMED FORCES OF UKRAINE
DOI:
https://doi.org/10.11603/1811-2471.2025.v.i1.15239Keywords:
traumatic brain injury, hypertonic saline, mannitol, mortality, survivalAbstract
SUMMARY. The aim – to search for systematic reviews and meta-analytic studies examining the treatment outcomes of patients with traumatic brain injury (TBI) undergoing hyperosmotic therapy with hypertonic sodium chloride solution compared to mannitol.
Material and Methods. The clinical question regarding the impact of hyperosmotic therapy with hypertonic sodium chloride solution on mortality rates of TBI patients, as compared to mannitol, was formulated using the PICO principle. A search was conducted among meta-analyses and systematic reviews in the PubMed database over the past five years (2019-2024) using the descriptors: “traumatic brain injury” AND “hypertonic saline” AND “mannitol” AND (“mortality” OR “survival rate”). Ten studies were included in the literature review.
Results. In all ten analyzed systematic reviews and meta-analyses, it was concluded that there are no significant differences between sodium chloride solution and mannitol regarding their effect on mortality in TBI patients with elevated ICP. However, several studies indicate certain secondary advantages of hypertonic saline over mannitol, such as a higher rate of successful ICP management, improvement in CPP within 30–60 minutes after hyperosmolar therapy, a shorter ICU stay, and prolonged therapeutic effects.
Conclusions. The implementation of hypertonic sodium chloride solution for the treatment of TBI patients in medical practice is justified, though the physical availability of this drug remains limited. The authors consider the most promising option to be the establishment of extemporaneous preparation of hypertonic sodium chloride solution in military hospital and military medical clinic pharmacies.
References
Chorna VV, Zavodiak AYu, Plakhotniuk IM, Lypkan VM, Tomashevskyi AV, Kolomiets VV. The characteristics of injuries from various types of weapons depend on the individual’s location at the moment of the explosion. 2024; (2):113–21 DOI: 10.32782/2077-6594/2024.2/19. DOI: https://doi.org/10.32782/2077-6594/2024.2/19
Chorna VV, Zavodiak AYu, Matviichuk MV, Ivashkevych YM, Syvak VM, Slobodian VV, et al. Tyazhkist' ushkodzhen' pry minno-vybukhoviy travmi zalezhno vid mistsya znakhodzhennya osoby na moment vybukhu [Severity of injuries in mine-blast trauma depending on the person's location at the time of the explosion]. Ukrainian Journal of Military Medicine. 2023; 4(3):70–7 DOI: 10.46847/ujmm.2023.3(4)-070. Ukrainian. DOI: https://doi.org/10.46847/ujmm.2023.3(4)-070
Horachuk VV, Krut AH, Oleksandr Ye. Kononov. Availability of rehabilitation for victims of mine-explosive injury in the conditions of territorial community. Wiadomości Lekarskie. 2024; 77(5):926–31. DOI: https://doi.org/10.36740/WLek202405107
Jha RM, Kochanek PM, Simard JM. Pathophysiology and treatment of cerebral edema in traumatic brain injury. Neuropharmacology. 2019; 145(Pt B):230–46. DOI: 10.1016/ j.neuropharm.2018.08.004 DOI: https://doi.org/10.1016/j.neuropharm.2018.08.004
Zhang W, Neal J, Lin L, Dai F, Hersey DP, McDonagh DL, et al. Mannitol in Critical Care and Surgery Over 50+ Years. Journal of Neurosurgical Anesthesiology. 2019; 31(3):273–84 DOI:10.1097/ANA.0000000000000520. DOI: https://doi.org/10.1097/ANA.0000000000000520
Susanto M, Riantri I. The Optimal Dose and Concentration of Hypertonic Saline in Traumatic Brain Injury - A Systematic Review. Medeniyet Medical Journal. 2022; 37(2). DOI: 10.4274/MMJ.galenos.2022.75725 DOI: https://doi.org/10.4274/MMJ.galenos.2022.75725
Novyy klinichnyy protokol neyrokhirurhiya i tyazhka travma holovy (boyovi poranennya) [New clinical protocol for neurosurgery and severe head trauma (combat injuries)] 2024. URL: https://www.dec.gov.ua/wp-content/uploads/ 2024/07/1237_22072024_dod_3.pdf Ukrainian.
Gu J, Huang H, Huang Y, Sun H, Xu H. Hypertonic saline or mannitol for treating elevated intracranial pressure in traumatic brain injury: a meta-analysis of randomized controlled trials. Neurosurgical Review. 2018; 42(2):499–509. DOI: 10.1007/s10143-018-0991-8 DOI: https://doi.org/10.1007/s10143-018-0991-8
Cai L, He W. Effectiveness of hypertonic saline infusion in management of traumatic brain injury: an updated systematic review and meta-analysis of randomized controlled trials. Brain injury. 2024; 10:1–8. DOI: 10.1080/ 02699052.2024.2363340
Armin Karamian, Seifi A, Lucke-Wold B. Comparing the effects of mannitol and hypertonic saline in severe traumatic brain injury patients with elevated intracranial pressure: a systematic review and meta-analysis. Neurological research. 2024; 1–10. DOI: 10.1080/01616412. 2024.2360862
Galushka AN, Podolyan YuV, Shvets AV, Gorshkov OO. Osoblyvosti boyovoho travmuvannya, shcho suprovodzhuvalosya akubarotravmoyu u viys'kovosluzhbovtsiv-uchasnykiv boyovykh diy [Features of combat trauma accompanied by acubarotrauma in military personnel participating in hostilities]. Ukrainian Journal of Military Medicine. 2019; 19(3). URL: https://doaj.org/article/6ffe3499c8bf4611aa4e208164ac3d5e Ukrainian.
DeNett, T, Feltner, C. Hypertonic saline versus mannitol for the treatment of increased intracranial pressure in traumatic brain injury. Journal of the American Association of Nurse Practitioners. 2019; 4(33). DOI: 10.1097/JXX.0000000000000340 DOI: https://doi.org/10.1097/JXX.0000000000000340
Chen H, Song Z, Dennis JA. Hypertonic saline versus other intracranial pressure-lowering agents for people with acute traumatic brain injury. Cochrane Database of Systematic Reviews. 2020; 1(1). DOI: 10.1002/14651858.CD010904.pub3 DOI: https://doi.org/10.1002/14651858.CD010904.pub3
Miyoshi Y, Kondo Y, Suzuki H, Fukuda T, Yasuda H, Yokobori S. Effects of hypertonic saline versus mannitol in patients with traumatic brain injury in prehospital, emergency department, and intensive care unit settings: a systematic review and meta-analysis. Journal of Intensive Care. 2020; 8(61). DOI: 10.1186/s40560-020-00476-x DOI: https://doi.org/10.1186/s40560-020-00476-x
Wang X, He Q, Ma L, You C. Comparison of different concentrations of hypertonic saline in patients with traumatic brain injury: Evidence from direct and indirect comparisons. Injury. 2022; 53(11):3729–35. DOI: 10.1016/j.injury.2022.08.065 DOI: https://doi.org/10.1016/j.injury.2022.08.065
Gharizadeh N, Ghojazadeh M, Naseri A, Dolati S, Tarighat F, Soleimanpour H. Hypertonic saline for traumatic brain injury: a systematic review and meta-analysis. European Journal of Medical Research. 2022; 27(1):254. DOI: 10.1186/s40001-022-00897-4 DOI: https://doi.org/10.1186/s40001-022-00897-4
Bernhardt K, McClune W, Rowland M, Shah A. Hypertonic Saline Versus Other Intracranial-Pressure-Lowering Agents for Patients with Acute Traumatic Brain Injury: A Systematic Review and Meta-analysis. 2024; 40(2):769-784. DOI: 10.1007/s12028-023-01771-9 DOI: https://doi.org/10.1007/s12028-023-01771-9
Tactical Combat Casualty Care (TCCC) Guidelines Basic Management Plan for Care Under Fire/Threat. 2024. Available from: https://tccc.org.ua/files/downloads/clinical-guidelines-2024-en.pdf
Pro zatverdzhennya Obsyahiv nadannya domedychnoyi dopomohy, yaki nadayut'sya pid chas vedennya boyovykh diy ta pidhotovky syl bezpeky i syl oborony za pryznachennyam u taktychnykh umovakh. Ofitsiynyy vebportal parlamentu Ukrayiny [On approval of the Scope of provision of home medical care provided during combat operations and training of security forces and defense forces for their intended purpose in tactical conditions. Official web portal of the Parliament of Ukraine]. 2024. URL: https://zakon.rada.gov.ua/laws/show/z0984-24#Text
Perelik likars'kykh zasobiv ta medychnykh vyrobiv, yakymy zabezpechuyet'sya osobovyy sklad syl bezpeky i syl oborony v skladi naplichnyka medychnoho boyovoho medyka/ starshoho boyovoho medyka (NMBM). Ofitsiynyy vebportal parlamentu Ukrayiny [List of medicines and medical devices provided to the personnel of the security forces and defense forces as part of the backpack of a combat medical officer/senior combat medical officer (CMME). Official web portal of the Parliament of Ukraine]. 2024. URL: https://zakon.rada.gov.ua/laws/show/z1174-24#n2 Ukrainian.
Derzhavnyy reyestr likars'kykh zasobiv Ukrayiny [State Register of Medicinal Products of Ukraine]. Drlz.com.ua. 2017. URL: http://www.drlz.com.ua/ Ukrainian.
Onlayn platforma [Online platform] TABLETKI.UA URL: https://tabletki.ua/uk/. Ukrainian
Liky Kontrol' CTO. Instruktsiya do preparata – Liky Kontrol'. [Medicines Control CTO. Instructions for the drug - Medicines Control]. 2016. URL: https://likicontrol.com.ua/ %D1 %96 %D0 %BD %D1 %81 %D1 %82 %D1 %80 %D1 %83 %D0 %BA %D1 %86 %D1 %96 %D1 %8F/?[40434]. Ukrainian.
Rezul'taty poshuku preparativ natriyu khlorydu na ofitsiynomu sayti TOV «Yuriya-Farm» [Search results for sodium chloride preparations on the official website of Yuria-Pharm LLC.] URL: https://www.uf.ua/?ref=prod&s= %D0 %BD %D0 %B0 %D1 %82 %D1 %80 %D1 %96 %D1 %8E+ %D1 %85 %D0 %BB %D0 %BE %D1 %80 %D0 %B8 %D0 %B4. Ukrainian.
Mason AK, Malik A, Ginglen JG. Hypertonic fluids. PubMed. Treasure Island (FL): StatPearls Publishing; 2023. URL: https://www.ncbi.nlm.nih.gov/books/NBK542194/
FDA. Drugs@FDA: FDA-Approved Drugs [Internet]. www.accessdata.fda.gov. URL: https://www.accessdata.fda.gov/scripts/cder/daf/index.cfm
Produktsiya PrAT «Infuziya» Infuzia.com [Products of PrJSC "Infuzia" Infuzia.com]. 2019. URL: http://www.infuzia.com/products/yes. Ukrainian.
Preparaty – TOV firma “Novofarm-Biosyntez” [Internet]. TOV firma “Novofarm-Biosyntez.” [Drugs – Novopharm-Biosyntez LLC [Internet]. Novopharm-Biosyntez LLC.] 2024. URL: https://novofarm.com.ua/preparaty/ Ukrainian.
PIC/S Guide to Good Manufacturing Practices of preparation of medicinal products in healthcare establishments (PIC/S PE 010-4) - ECA Academy. URL: https://www.gmp-compliance.org/guidelines/gmp-guideline/pic-s-guide-to-good-manufacturing-practices-of-preparation-of-medicinal-products-in-healthcare-establishments-pic-s-pe-010-4
