Please use this identifier to cite or link to this item: http://ahro.austin.org.au/austinjspui/handle/1/21701
Title: Serum sodium and intracranial pressure changes after desmopressin therapy in severe traumatic brain injury patients: a multi-centre cohort study.
Authors: Harrois, A;Anstey, J R;Taccone, F S;Udy, A A;Citerio, G;Duranteau, J;Ichai, C;Badenes, R;Prowle, J R;Ercole, A;Oddo, M;Schneider, A;van der Jagt, M;Wolf, S;Helbok, R;Nelson, D W;Skrifvars, M B;Cooper, D J;Bellomo, Rinaldo
Affiliation: Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventative Medicine, Monash University, Melbourne, VIC, Australia
Intensive Care Unit, Royal Melbourne Hospital, Parkville, VIC, Australia
School of Medicine, University of Melbourne, Melbourne, Australia
Department of Anesthesia and Surgical Intensive Care, CHU de Bicetre, APHP, Université Paris Sud, 78 Rue du Général Leclerc, 94270, Le Kremlin Bicêtre, France
Intensive Care Unit, The Alfred Hospital, Melbourne, VIC, Australia
Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
Department of Intensive Care, Austin Health, Heidelberg, Victoria, Australia
Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
School of Medicine and Surgery, University Milano Bicocca-Neurointensive Care, San Gerardo Hospital, ASST-Monza, Monza, Italy
Department of Anesthesia and Surgical Intensive Care, CHU de Bicetre, APHP, Université Paris Sud, 78 Rue du Général Leclerc, 94270, Le Kremlin Bicêtre, France
Université Côte d'Azur, Centre hospitalier Universitaire de Nice, Service de Réanimation Polyvalente, Hôpital Pasteur 2, Nice, France
Department of Anesthesiology and Surgical-Trauma Intensive Care, Hospital Clinic Universitari de Valencia, University of Valencia, Valencia, Spain
Adult Critical Care Unit, The Royal London Hospital, Barts Health NHS Trust, London, UK
Neurosciences and Trauma Critical Care Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
Department of Medical-Surgical Intensive Care Medicine, Faculty of Biology and Medicine, Centre Hospitalier Universitaire, Vaudois (CHUV), University of Lausanne, Lausanne, Switzerland
Department of Intensive Care, Erasmus MC-University Medical Center, Rotterdam, The Netherlands
Department of Neurosurgery, Charité Universitätsmedizin Berlin, Berlin, Germany
Neurological Intensive Care Unit, Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
Section for Perioperative Medicine and Intensive Care, Department of Physiology and Pharmacology, Karolinska Institute, Stockholm, Sweden
Division of Intensive Care, Department of Emergency Care and Services, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
Issue Date: 5-Sep-2019
EDate: 2019-09-05
Citation: Annals of intensive care 2019; 9(1): 99
Abstract: In traumatic brain injury (TBI) patients desmopressin administration may induce rapid decreases in serum sodium and increase intracranial pressure (ICP). In an international multi-centre study, we aimed to report changes in serum sodium and ICP after desmopressin administration in TBI patients. We obtained data from 14 neurotrauma ICUs in Europe, Australia and UK for severe TBI patients (GCS ≤ 8) requiring ICP monitoring. We identified patients who received any desmopressin and recorded daily dose, 6-hourly serum sodium, and 6-hourly ICP. We studied 262 severe TBI patients. Of these, 39 patients (14.9%) received desmopressin. Median length of treatment with desmopressin was 1 [1-3] day and daily intravenous dose varied between centres from 0.125 to 10 mcg. The median hourly rate of decrease in serum sodium was low (- 0.1 [- 0.2 to 0.0] mmol/L/h) with a median period of decrease of 36 h. The proportion of 6-h periods in which the rate of natremia correction exceeded 0.5 mmol/L/h or 1 mmol/L/h was low, at 8% and 3%, respectively, and ICPs remained stable. After adjusting for IMPACT score and injury severity score, desmopressin administration was independently associated with increased 60-day mortality [HR of 1.83 (1.05-3.24) (p = 0.03)]. In severe TBI, desmopressin administration, potentially representing instances of diabetes insipidus is common and is independently associated with increased mortality. Desmopressin doses vary markedly among ICUs; however, the associated decrease in natremia rarely exceeds recommended rates and median ICP values remain unchanged. These findings support the notion that desmopressin therapy is safe.
URI: http://ahro.austin.org.au/austinjspui/handle/1/21701
DOI: 10.1186/s13613-019-0574-z
ORCID: 0000-0002-5098-4656
0000-0002-1650-8939
PubMed URL: 31486921
ISSN: 2110-5820
Type: Journal Article
Subjects: Desmopressin
Diabetes insipidus
Natremia
Sodium
Traumatic brain injury
Appears in Collections:Journal articles

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