Oh, what a shocking revelation we have here! After diving into the depths of two massive databases, the MIMIC-IV and eICU-CRD, researchers have unearthed the astonishing fact that hypertonic saline (HTS) might just have some effects on those poor souls with traumatic brain injury (TBI) in the ICU. Who would’ve thought that pouring salt into the bloodstream could do more than just season the cells, right?

So, they rounded up 1955 patients, and guess what? Only 130 of them had the pleasure of experiencing the salty embrace of HTS. With the help of the magical marginal structural Cox model (MSCM), which sounds like a spell straight out of a wizard’s handbook, they discovered that HTS was like a party invitation for infections, particularly those pesky urinary tract ones (HR 1.88, p=0.002). And for an encore, it rolled out the red carpet for extended ICU vacations (HR 2.02, p<0.001).

But wait, there’s a twist! In the land of brain pressure, if you were part of the ‘medium’ or ‘low’ intracranial pressure club, HTS might just be your knight in shining armor, giving you a little boost in the Glasgow Coma Scale (GCS) department. Mortality, though? HTS seems to be a bit shy there, not making any significant moves.

And let’s not forget the grand finale: a symphony of infection rates and electrolyte imbalances, the inevitable encore to the continuous HTS infusion show. The researchers, in their infinite wisdom, suggest that maybe—just maybe—we should take these slight benefits with a grain of salt (pun intended) and look into it a bit more. Because, you know, basing clinical decisions on massive, impersonal databases is always how you get the most personalized care.