A prospective, randomized, and controlled study of fluid management in children with severe head injury
| Autor: | B Simma, P Sacher, R Burger, M Falk, S Fanconi |
|---|---|
| Rok vydání: | 1998 |
| Předmět: |
Osmole
medicine.medical_specialty Severe head injury medicine.diagnostic_test business.industry Head injury Glasgow Coma Scale Fluid management Hematocrit Critical Care and Intensive Care Medicine medicine.disease Surgery Hypertonic saline Anesthesiology and Pain Medicine Anesthesia Intensive care Medicine Ringer's solution Neurology (clinical) business Intracranial pressure |
| Zdroj: | Critical Care Medicine. 26:1265-1270 |
| ISSN: | 0090-3493 |
| Popis: | OBJECTIVES Resuscitation in severe head injury may be detrimental when given with hypotonic fluids. We evaluated the effects of lactated Ringer's solution (sodium 131 mmol/L, 277 mOsm/L) compared with hypertonic saline (sodium 268 mmol/L, 598 mOsm/L) in severely head-injured children over the first 3 days after injury. DESIGN An open, randomized, and prospective study. SETTING A 16-bed pediatric intensive care unit (ICU) (level III) at a university children's hospital. PATIENTS A total of 35 consecutive children with head injury. INTERVENTIONS Thirty-two children with Glasgow Coma Scores of 92%, and hematocrit of >0.30). MEASUREMENTS AND MAIN RESULTS Mean arterial pressure and intracranial pressure (ICP) were monitored continuously and documented hourly and at every intervention. The means of every 4-hr period were calculated and serum sodium concentrations were measured at the same time. An ICP of 15 mm Hg was treated with a predefined sequence of interventions, and complications were documented. There was no difference with respect to age, male/female ratio, or initial Glasgow Coma Score. In both groups, there was an inverse correlation between serum sodium concentration and ICP (group 1: r = -.13, r2 = .02, p < .03; group 2: r = -.29, r2 = .08, p < .001) that disappeared in group 1 and increased in group 2 (group 1: r = -.08, r2 = .01, NS; group 2: r = -.35, r2 =.12, p < .001). Correlation between serum sodium concentration and cerebral perfusion pressure (CPP) became significant in group 2 after 8 hrs of treatment (r = .2, r2 = .04, p = .002). Over time, ICP and CPP did not significantly differ between the groups. However, to keep ICP at |
| Databáze: | OpenAIRE |
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