Sodium lactate versus mannitol in the treatment of intracranial hypertensive episodes in severe traumatic brain-injured patients
| Autor: | Frederic Berthier, Xavier Leverve, Corine Samat-Long, Dominique Grimaud, Laurent Rami, Guy Armando, Carole Ichai, Jean-Christophe Orban |
|---|---|
| Přispěvatelé: | Service de réanimation, Centre Hospitalier Universitaire de Nice (CHU Nice)-Hôpital St Roch, Département d'Informatique Médicale, Centre Hospitalier Universitaire de Nice (CHU Nice)-Hôpital Cimiez [Nice] (CHU), Laboratoire de bioénergétique fondamentale et appliquée (LBFA), Université Joseph Fourier - Grenoble 1 (UJF)-Institut National de la Santé et de la Recherche Médicale (INSERM), Hamant, Sarah, Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Joseph Fourier - Grenoble 1 (UJF) |
| Rok vydání: | 2008 |
| Předmět: |
Adult
Male Traumatic brain injury medicine.medical_treatment Brain Edema Critical Care and Intensive Care Medicine Cerebral edema Sodium Lactate Disability Evaluation 03 medical and health sciences Injury Severity Score 0302 clinical medicine Osmotherapy Intensive care [SDV.BBM] Life Sciences [q-bio]/Biochemistry Molecular Biology medicine Humans Glasgow Coma Scale Mannitol [SDV.BBM]Life Sciences [q-bio]/Biochemistry Molecular Biology Prospective Studies business.industry 030208 emergency & critical care medicine medicine.disease Diuretics Osmotic 3. Good health Hypertonic saline Intensive Care Units Brain Injuries Anesthesia Female Intracranial Hypertension Diuretic business 030217 neurology & neurosurgery medicine.drug |
| Zdroj: | Annales Françaises d'Anesthésie et de Réanimation Annales Françaises d'Anesthésie et de Réanimation, Elsevier Masson, 2009, 35 (3), pp.471-9. ⟨10.1007/s00134-008-1283-5⟩ |
| ISSN: | 1432-1238 0342-4642 0750-7658 |
| DOI: | 10.1007/s00134-008-1283-5 |
| Popis: | Traumatic brain injury (TBI) is still a major cause of mortality and morbidity. Recent trials have failed to demonstrate a beneficial outcome from therapeutic treatments such as corticosteroids, hypothermia and hypertonic saline. We investigated the effect of a new hyperosmolar solution based on sodium lactate in controlling raised intracranial pressure (ICP).Prospective open randomized study in an adult ICU.Thirty-four patients with isolated severe TBI (Glasgow Coma Scaleor= 8) and intracranial hypertension were allocated to receive equally hyperosmolar and isovolumic therapy, consisting of either mannitol or sodium lactate. Rescue therapy by crossover to the alternative treatment was indicated when ICP could not be controlled. The primary endpoint was efficacy in lowering ICP after 4 h, with a secondary endpoint of the percentage of successfully treated episodes of intracranial hypertension. The analysis was performed with both intention-to-treat and actual treatments provided.Compared to mannitol, the effect of the lactate solution on ICP was significantly more pronounced (7 vs. 4 mmHg, P = 0.016), more prolonged (fourth-hour-ICP decrease: -5.9 +/- 1 vs. -3.2 +/- 0.9 mmHg, P = 0.009) and more frequently successful (90.4 vs. 70.4%, P = 0.053).Acute infusion of a sodium lactate-based hyperosmolar solution is effective in treating intracranial hypertension following traumatic brain injury. This effect is significantly more pronounced than that of an equivalent osmotic load of mannitol. Additionally, in this specific group of patients, long-term outcome was better in terms of GOS in those receiving as compared to mannitol. Larger trials are warranted to confirm our findings. |
| Databáze: | OpenAIRE |
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