Cargando…

Comparison of Weight-Based Dosing versus Fixed Dosing of 23.4% Hypertonic Saline for Intracranial Pressure Reduction in Patients with Severe Traumatic Brain Injury

CONTEXT: Hypertonic saline (HTS) is a pharmacologic therapy used in patients with severe traumatic brain injuries to decrease intracranial pressure (ICP) associated with cerebral edema. AIMS: The purpose of this study was to compare ICP reduction between fixed doses of 23.4% HTS and weight-based dos...

Descripción completa

Detalles Bibliográficos
Autores principales: Busey, Kirsten, Ferreira, Jason, Aldridge, Petra, Crandall, Marie, Johnson, Donald
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Wolters Kluwer - Medknow 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8047962/
https://www.ncbi.nlm.nih.gov/pubmed/33897140
http://dx.doi.org/10.4103/JETS.JETS_66_19
_version_ 1783679149324369920
author Busey, Kirsten
Ferreira, Jason
Aldridge, Petra
Crandall, Marie
Johnson, Donald
author_facet Busey, Kirsten
Ferreira, Jason
Aldridge, Petra
Crandall, Marie
Johnson, Donald
author_sort Busey, Kirsten
collection PubMed
description CONTEXT: Hypertonic saline (HTS) is a pharmacologic therapy used in patients with severe traumatic brain injuries to decrease intracranial pressure (ICP) associated with cerebral edema. AIMS: The purpose of this study was to compare ICP reduction between fixed doses of 23.4% HTS and weight-based doses. SETTING AND DESIGN: This was a retrospective study that included adult patients at a level 1 trauma center who had nonpenetrating traumatic brain injury, an ICP monitor, and received at least one dose of 23.4% HTS. SUBJECTS AND METHODS: Doses were classified as either high weight-based (>0.6 ml/kg), low weight-based (<0.6 ml/kg), or standard fixed dose (30 ml). Only doses given within 5 days post-injury were evaluated. Percent reduction in ICP was compared pre- and post-dose between dosing groups, and each dose was evaluated as a separate episode. STATISTICAL ANALYSIS: The primary and secondary endpoints for the study were analyzed using mixed-model, repeated-measures analysis of covariance. RESULTS: A total of 97 doses of HTS were evaluated. The primary endpoint of ICP reduction showed a 42.5% decrease in ICP after the administration of a high weight-based dose, a 36.7% reduction after a low weight-based dose, and a 31.5% reduction after a fixed dose. There was no significant relationship between dose group and percent change in ICP (P = 0.25). A sub-analysis of doses received within 48 h postinjury found a significant relationship between both dose group and percent change in ICP, and initial ICP and percent change in ICP (P = 0.04, and <0.0001 respectively). CONCLUSIONS: Our data did not show a significant difference between fixed- and weight-based doses of 23.4% HTS for ICP reduction.
format Online
Article
Text
id pubmed-8047962
institution National Center for Biotechnology Information
language English
publishDate 2020
publisher Wolters Kluwer - Medknow
record_format MEDLINE/PubMed
spelling pubmed-80479622021-04-23 Comparison of Weight-Based Dosing versus Fixed Dosing of 23.4% Hypertonic Saline for Intracranial Pressure Reduction in Patients with Severe Traumatic Brain Injury Busey, Kirsten Ferreira, Jason Aldridge, Petra Crandall, Marie Johnson, Donald J Emerg Trauma Shock Original Article CONTEXT: Hypertonic saline (HTS) is a pharmacologic therapy used in patients with severe traumatic brain injuries to decrease intracranial pressure (ICP) associated with cerebral edema. AIMS: The purpose of this study was to compare ICP reduction between fixed doses of 23.4% HTS and weight-based doses. SETTING AND DESIGN: This was a retrospective study that included adult patients at a level 1 trauma center who had nonpenetrating traumatic brain injury, an ICP monitor, and received at least one dose of 23.4% HTS. SUBJECTS AND METHODS: Doses were classified as either high weight-based (>0.6 ml/kg), low weight-based (<0.6 ml/kg), or standard fixed dose (30 ml). Only doses given within 5 days post-injury were evaluated. Percent reduction in ICP was compared pre- and post-dose between dosing groups, and each dose was evaluated as a separate episode. STATISTICAL ANALYSIS: The primary and secondary endpoints for the study were analyzed using mixed-model, repeated-measures analysis of covariance. RESULTS: A total of 97 doses of HTS were evaluated. The primary endpoint of ICP reduction showed a 42.5% decrease in ICP after the administration of a high weight-based dose, a 36.7% reduction after a low weight-based dose, and a 31.5% reduction after a fixed dose. There was no significant relationship between dose group and percent change in ICP (P = 0.25). A sub-analysis of doses received within 48 h postinjury found a significant relationship between both dose group and percent change in ICP, and initial ICP and percent change in ICP (P = 0.04, and <0.0001 respectively). CONCLUSIONS: Our data did not show a significant difference between fixed- and weight-based doses of 23.4% HTS for ICP reduction. Wolters Kluwer - Medknow 2020 2020-12-07 /pmc/articles/PMC8047962/ /pubmed/33897140 http://dx.doi.org/10.4103/JETS.JETS_66_19 Text en Copyright: © 2020 Journal of Emergencies, Trauma, and Shock https://creativecommons.org/licenses/by-nc-sa/4.0/This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.
spellingShingle Original Article
Busey, Kirsten
Ferreira, Jason
Aldridge, Petra
Crandall, Marie
Johnson, Donald
Comparison of Weight-Based Dosing versus Fixed Dosing of 23.4% Hypertonic Saline for Intracranial Pressure Reduction in Patients with Severe Traumatic Brain Injury
title Comparison of Weight-Based Dosing versus Fixed Dosing of 23.4% Hypertonic Saline for Intracranial Pressure Reduction in Patients with Severe Traumatic Brain Injury
title_full Comparison of Weight-Based Dosing versus Fixed Dosing of 23.4% Hypertonic Saline for Intracranial Pressure Reduction in Patients with Severe Traumatic Brain Injury
title_fullStr Comparison of Weight-Based Dosing versus Fixed Dosing of 23.4% Hypertonic Saline for Intracranial Pressure Reduction in Patients with Severe Traumatic Brain Injury
title_full_unstemmed Comparison of Weight-Based Dosing versus Fixed Dosing of 23.4% Hypertonic Saline for Intracranial Pressure Reduction in Patients with Severe Traumatic Brain Injury
title_short Comparison of Weight-Based Dosing versus Fixed Dosing of 23.4% Hypertonic Saline for Intracranial Pressure Reduction in Patients with Severe Traumatic Brain Injury
title_sort comparison of weight-based dosing versus fixed dosing of 23.4% hypertonic saline for intracranial pressure reduction in patients with severe traumatic brain injury
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8047962/
https://www.ncbi.nlm.nih.gov/pubmed/33897140
http://dx.doi.org/10.4103/JETS.JETS_66_19
work_keys_str_mv AT buseykirsten comparisonofweightbaseddosingversusfixeddosingof234hypertonicsalineforintracranialpressurereductioninpatientswithseveretraumaticbraininjury
AT ferreirajason comparisonofweightbaseddosingversusfixeddosingof234hypertonicsalineforintracranialpressurereductioninpatientswithseveretraumaticbraininjury
AT aldridgepetra comparisonofweightbaseddosingversusfixeddosingof234hypertonicsalineforintracranialpressurereductioninpatientswithseveretraumaticbraininjury
AT crandallmarie comparisonofweightbaseddosingversusfixeddosingof234hypertonicsalineforintracranialpressurereductioninpatientswithseveretraumaticbraininjury
AT johnsondonald comparisonofweightbaseddosingversusfixeddosingof234hypertonicsalineforintracranialpressurereductioninpatientswithseveretraumaticbraininjury