Hypertonic Saline is Superior to Mannitol for the Combined Effect on Intracranial Pressure and Cerebral Perfusion Pressure Burdens in Patients With Severe Traumatic Brain Injury
Hypertonic Saline is Superior to Mannitol for the Combined Effect on Intracranial Pressure and Cerebral Perfusion Pressure Burdens in Patients With Severe Traumatic Brain Injury
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DOI：
10.1093/neuros/nyz046
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发表时间：
2020-02-01
期刊：
影响因子：
4.8
通讯作者：
Hartl, Roger
中科院分区：
文献类型：
--
作者：
Mangat, Halinder S.;Wu, Xian;Hartl, Roger
高渗盐水和甘露醇可有效降低重型颅脑损伤后颅内压。然而，他们的同时对脑灌注压（CPP）和ICP的影响还没有严格studyed.Objective确定HTS和甘露醇的影响的差异，对高ICP和低CPP的综合负担的患者严重TBI.METHODS我们进行了一项病例对照研究，前瞻性收集的数据来自纽约州TBI-trac（R）数据库（脑创伤基金会，纽约，纽约）。仅接受1种高渗药物（甘露醇或HTS）治疗ICP升高的患者纳入研究。两组患者的2周死亡率相关因素匹配（1：1和1：2）：年龄、格拉斯哥昏迷评分、瞳孔反应性、低血压、异常计算机断层扫描和开颅术。主要终点为ICP高（> 25 mm Hg）和CPP低（< 60 mm Hg）的联合负荷。结果：1：1比较中有25对匹配，1：2比较中有24例HTS患者与48例甘露醇患者匹配。两组的累积中位渗透剂量相似。在接受HTS治疗的患者中，与甘露醇相比，（0.6 ± 0.8 vs 2.4 ± 2.3 d，P <0.01），（8.8 +/- 10.6 vs 28.1 +/-26.9%，P < .01），ICP高+CPP低的总持续时间（11.12 +/- 14.11 vs 30.56 +/- 31.89 h，P = .01）显著降低。这些结果在1：2的匹配comparation.CONCLUSION HTS团注治疗似乎是上级甘露醇在减少颅内高压和相关的低灌注的严重TBI患者的联合负担。
BACKGROUND Hypertonic saline (HTS) and mannitol are effective in reducing intracranial pressure (ICP) after severe traumatic brain injury (TBI). However, their simultaneous effect on the cerebral perfusion pressure (CPP) and ICP has not been studied rigorously.OBJECTIVE To determine the difference in effects of HTS and mannitol on the combined burden of high ICP and low CPP in patients with severe TBI.METHODS We performed a case-control study using prospectively collected data from the New York State TBI-trac (R) database (Brain Trauma Foundation, New York, New York). Patients who received only 1 hyperosmotic agent, either mannitol or HTS for raised ICP, were included. Patients in the 2 groups were matched (1:1 and 1:2) for factors associated with 2-wk mortality: age, Glasgow Coma Scale score, pupillary reactivity, hypotension, abnormal computed tomography scans, and craniotomy. Primary endpoint was the combined burden of ICPhigh (> 25 mm Hg) and CPPlow (< 60 mm Hg).RESULTS There were 25 matched pairs for 1:1 comparison and 24 HTS patients matched to 48 mannitol patients in 1:2 comparisons. Cumulative median osmolar doses in the 2 groups were similar. In patients treated with HTS compared to mannitol, total number of days (0.6 0.8 vs 2.4 +/- 2.3 d, P < .01), percentage of days with (8.8 +/- 10.6 vs 28.1 +/- 26.9%, P < .01), and the total duration of ICPhigh + CPPlow (11.12 +/- 14.11 vs 30.56 +/- 31.89 h, P = .01) were significantly lower. These results were replicated in the 1:2 match comparisons.CONCLUSION HTS bolus therapy appears to be superior to mannitol in reduction of the combined burden of intracranial hypertension and associated hypoperfusion in severe TBI patients.