Hypertonic saline for stroke with cerebral edema

3% saline infusions have become standard care for increased intracranial pressure at many centers, based on mostly anecdotal evidence. Hauer et al looked retrospectively at 100 patients receiving 3% saline for severe stroke in 2008-2009 (intracerebral hemorrhage, subarachnoid hemorrhage, or ischemic) and compared them to 115 historical controls, 2007-2008 with "equal" underlying disease. Hypertonic saline was associated with fewer episodes of critically elevated intracranial pressure (92 vs 167) and lower mortality (17 vs. 30%), without increased adverse events. Crit Care Med 2011;39:1766-1772.