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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...
Autores principales: | , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Wolters Kluwer - Medknow
2020
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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 |
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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 |
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