The effect of continuous hypertonic saline infusion and hypernatremia on mortality in patients with severe traumatic brain injury: a retrospective cohort study

被引：1

作者：

Tan, Sean K. R. ^{[1
]}

Kolmodin, Leif ^{[1
]}

Sekhon, Mypinder S. ^{[2
]}

Qiao, Lu ^{[1
]}

Zou, Jie ^{[1
]}

Henderson, William R. ^{[2
]}

Griesdale, Donald E. G. ^{[2
,3
,4
,5
]}

机构：

[1] Univ British Columbia, Fac Med, Vancouver, BC, Canada

[2] Univ British Columbia, Dept Med, Div Crit Care Med, Vancouver, BC, Canada

[3] Univ British Columbia, Dept Anesthesiol Pharmacol & Therapeut, Vancouver, BC V5Z 1M9, Canada

[4] Vancouver Coastal Hlth Res Inst, Ctr Clin Epidemiol & Evaluat, Vancouver, BC, Canada

[5] Vancouver Gen Hosp, Crit Care Med, Room 2438,Jim Pattison Pavil,2nd Floor, Vancouver, BC V5Z 1M9, Canada

来源：

CANADIAN JOURNAL OF ANESTHESIA-JOURNAL CANADIEN D ANESTHESIE | 2016年 / 63卷 / 06期

关键词：

INCREASED INTRACRANIAL-PRESSURE; CEREBRAL PERFUSION-PRESSURE; INTENSIVE-CARE-UNIT; HYPEROSMOLAR THERAPY; CRITICALLY-ILL; HEAD-INJURY; EPIDEMIOLOGY; HYPERTENSION; MANNITOL; EDEMA;

D O I：

10.1007/s12630-016-0633-y

中图分类号：

R614 [麻醉学];

学科分类号：

100217 ;

摘要：

Hypertonic saline (HTS) is used to control intracranial pressure (ICP) in patients with traumatic brain injury (TBI); however, in prior studies, the resultant hypernatremia has been associated with increased mortality. We aimed to study the effect of HTS on ICP and mortality in patients with severe TBI. We performed a retrospective cohort study of 231 patients with severe TBI (Glasgow Coma Scale [GCS] a parts per thousand currency sign 8) admitted to two neurotrauma units from 2006-2012. We recorded daily HTS, ICP, and serum sodium (Na) concentration. We used Cox proportional regression modelling for hospital mortality and incorporated the following time-dependent variables: use of HTS, hypernatremia, and desmopressin administration. The mean [standard deviation (SD)] age of patients was 34 (17) and the median (interquartile range [IQR]) GCS was 6 [3-8]. Hypertonic saline was administered as a continuous infusion in 124 of 231 (54%) patients over 788 of 2,968 (27%) patient-days. Hypernatremia (Na > 145 mmol center dot L-1) developed in 151 of 231 (65%) patients over 717 of 2,968 (24%) patients-days. In patients who developed hypernatremia, the median [IQR] Na was 146 [142-147] mmol center dot L-1. Overall hospital mortality was 26% (59 of 231 patients). After adjusting for baseline covariates, neither HTS (hazard ratio [HR], 1.07; 95% confidence interval [CI], 0.56 to 2.05; P = 0.84) nor hypernatremia (HR, 1.31; 95% CI, 0.68 to 2.55; P = 0.42) was associated with hospital mortality. There was no effect modification by either HTS or hypernatremia on each another. Patients who received HTS observed a significant decrease in ICP during their ICU stay compared with those who did not receive HTS (4 mmHg; 95% CI, 2 to 6; P < 0.001 vs 2 mmHg; 95% CI, -1 to 5; P = 0.14). Hypertonic saline and hypernatremia are not associated with hospital mortality in patients with severe TBI.

引用

页码：664 / 673

页数：10