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Title: Early Osmotherapy in Severe Traumatic Brain Injury: An International Multicenter Study.
Austin Authors: Anstey, James R;Taccone, Fabio S;Udy, Andrew A;Citerio, Giuseppe;Duranteau, Jacques;Ichai, Carole;Badenes, Rafael;Prowle, John R;Ercole, Ari;Oddo, Mauro;Schneider, Antoine G;van der Jagt, Mathieu;Wolf, Stefan;Helbok, Raimund;Nelson, David W;Skrifvars, Marius B;Harrois, Anatole;Presneill, Jeffrey;Cooper, D Jamie;Bailey, Michael;Bellomo, Rinaldo 
Affiliation: Division of Intensive Care, Department of Anaesthesiology, Intensive Care and Pain Medicine and Department of Emergency Medicine and Services, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
Intensive Care Unit, Royal Melbourne Hospital, Parkville, Victoria, Australia
Department of Anesthesia and Surgical Intensive Care, CHU de Bicetre, Le Kremlin Bicêtre, Le Kremlin-Bicêtre, France
Intensive Care Unit, The Alfred Hospital, Melbourne, Victoria, Australia
Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventative Medicine, Monash University, ANZIC-RC, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia
Intensive Care
Department of Medicine and Radiology, University of Melbourne, Parkville, Victoria, Australia
Department of Neurosurgery, Charité Universitätsmedizin Neuro Intensive Care Unit 102i, Campus Charité Mitte (CCM), Berlin, Germany
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, Le Kremlin Bicêtre, Le Kremlin-Bicêtre, France
Université Côte d'Azur, Centre hospitalier Universitaire de Nice, Service de Réanimation polyvalente, Hôpital Pasteur 2, CHU de Nice, 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, Royal London Hospital, Whitechapel Road, London, United Kingdom
Neurosciences and Trauma Critical Care Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
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 Centre, Erasmus MC-University Medical Center, Rotterdam, The Netherlands
Neurological Intensive Care Unit, Department of Neurology, Medical University of Innsbruck, Department of Neurology, Neurocritical Care Unit, Innsbruck, Austria
Section for Perioperative Medicine and Intensive Care, Department of Physiology and Pharmacology, Karolinska Institute, Stockholm, Sweden
Issue Date: Jan-2020
Date: 2019-09-10
Publication information: Journal of Neurotrauma 2020; 37(1): 178-184
Abstract: The optimal osmotic agent to treat intracranial hypertension in patients with severe traumatic brain injury (TBI) remains uncertain. We aimed to test whether the choice of mannitol or hypertonic saline (HTS) as early (first 96 h) osmotherapy in these patients might be associated with a difference in mortality. We retrospectively analyzed data from 2015 from 14 tertiary intensive care units (ICUs) in Australia, UK, and Europe treating severe TBI patients with intracranial pressure (ICP) monitoring and compared mortality in those who received mannitol only versus HTS only. We performed multi-variable analysis adjusting for site and illness severity (Injury Severity Score, extended IMPACT score, and mean ICP over the first 96 h) using Cox proportional hazards regression. We collected data on 262 patients and compared patients who received early osmotherapy with mannitol alone (n = 46) with those who received HTS alone (n = 46). Mannitol patients were older (median age, 49.2 (19.2) vs. 40.5 (16.8) years; p = 0.02), with higher Injury Severity Scores (42 (15.9) vs. 32.1 [11.3]; p = 0.001), and IMPACT-TBI predicted 6-month mortality (34.5% [23-46] vs. 25% [13-38]; p = 0.02), but had similar APACHE-II scores, and mean and maximum ICPs over the first 96 h. The unadjusted hazard ratio for in-hospital mortality in patients receiving only mannitol was 3.35 (95% confidence interval [CI], 1.60-7.03; p = 0.001). After adjustment for key mortality predictors, the hazard ratio for in-hospital mortality in patients receiving only mannitol was 2.64 (95% CI, 0.96-7.30; p = 0.06). The choice of early osmotherapy in severe TBI patients may affect survival, or simply reflect clinician beliefs about their different roles, and warrants controlled investigation.
DOI: 10.1089/neu.2019.6399
Journal: Journal of Neurotrauma
PubMed URL: 31286839
Type: Journal Article
Subjects: hypertonic saline
traumatic brain injury
Appears in Collections:Journal articles

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