There has been substantial retrospective data and limited prospective data in children which suggests that hypertonic saline (HTS) can improve the control of intracranial pressure (ICP) in patients with acute brain injury. In 1992, a report published by the Journal of Neurosurgical Anesthesiology indicated that HTS reduced elevated ICP in children after head injury. This study looked at a single intravenous bolus of HTS in comparison to the same volume of normal saline and demonstrated a clear difference. Subsequently, it was demonstrated that HTS appears to be efficacious in controlling ICP. In a retrospective chart review, 68 children with closed head injury were cared for using a standardized protocol and the intravenous infusion of 3% HTS in quantities designed to drive the serum sodium to levels that would reduce the ICP to less than 20 mmHg. Of the patients in who HTS was used, only 3 patients (4%) died of uncontrolled ICP. Of note, there were no adverse effects of super-physiologic hyperosmolarity such as renal failure, pulmonary edema, or central pontine demyelination.