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Early use of barbiturates is associated with increased mortality in traumatic brain injury patients from a propensity score-based analysis of a prospective cohort

Barbiturates are proposed as a second/third line treatment for intracranial hypertension in traumatic brain injury (TBI) patients, but the literature remains uncertain regarding their benefit/risk balance. We aimed to evaluate the impact of barbiturates therapy in TBI patients with early intracrania...

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Autores principales: Léger, Maxime, Frasca, Denis, Roquilly, Antoine, Seguin, Philippe, Cinotti, Raphaël, Dahyot-Fizelier, Claire, Asehnoune, Karim, Le Borgne, Florent, Gaillard, Thomas, Foucher, Yohann, Lasocki, Sigismond
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9067881/
https://www.ncbi.nlm.nih.gov/pubmed/35507627
http://dx.doi.org/10.1371/journal.pone.0268013
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author Léger, Maxime
Frasca, Denis
Roquilly, Antoine
Seguin, Philippe
Cinotti, Raphaël
Dahyot-Fizelier, Claire
Asehnoune, Karim
Le Borgne, Florent
Gaillard, Thomas
Foucher, Yohann
Lasocki, Sigismond
author_facet Léger, Maxime
Frasca, Denis
Roquilly, Antoine
Seguin, Philippe
Cinotti, Raphaël
Dahyot-Fizelier, Claire
Asehnoune, Karim
Le Borgne, Florent
Gaillard, Thomas
Foucher, Yohann
Lasocki, Sigismond
author_sort Léger, Maxime
collection PubMed
description Barbiturates are proposed as a second/third line treatment for intracranial hypertension in traumatic brain injury (TBI) patients, but the literature remains uncertain regarding their benefit/risk balance. We aimed to evaluate the impact of barbiturates therapy in TBI patients with early intracranial hypertension on the intensive care unit (ICU) survival, the occurrence of ventilator-associated pneumonia (VAP), and the patient’s functional status at three months. We used the French AtlanREA prospective cohort of trauma patients. Using a propensity score-based methodology (inverse probability of treatment weighting), we compared patients having received barbiturates within the first 24 hours of admission (barbiturates group) and those who did not (control group). We used cause-specific Cox models for ICU survival and risk of VAP, and logistic regression for the 3-month Glasgow Outcome Scale (GOS) evaluation. Among the 1396 patients with severe trauma, 383 had intracranial hypertension on admission and were analyzed. Among them, 96 (25.1%) received barbiturates. The early use of barbiturates was significantly associated with increased ICU mortality (HR = 1.85, 95%CI 1.03–3.33). However, barbiturates treatment was not significantly associated with VAP (HR = 1.02, 95%CI 0.75–1.41) or 3-month GOS (OR = 1.67, 95%CI 0.84–3.33). Regarding the absence of relevant clinical trials, our results suggest that each early prescription of barbiturates requires a careful assessment of the benefit/risk ratio.
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spelling pubmed-90678812022-05-05 Early use of barbiturates is associated with increased mortality in traumatic brain injury patients from a propensity score-based analysis of a prospective cohort Léger, Maxime Frasca, Denis Roquilly, Antoine Seguin, Philippe Cinotti, Raphaël Dahyot-Fizelier, Claire Asehnoune, Karim Le Borgne, Florent Gaillard, Thomas Foucher, Yohann Lasocki, Sigismond PLoS One Research Article Barbiturates are proposed as a second/third line treatment for intracranial hypertension in traumatic brain injury (TBI) patients, but the literature remains uncertain regarding their benefit/risk balance. We aimed to evaluate the impact of barbiturates therapy in TBI patients with early intracranial hypertension on the intensive care unit (ICU) survival, the occurrence of ventilator-associated pneumonia (VAP), and the patient’s functional status at three months. We used the French AtlanREA prospective cohort of trauma patients. Using a propensity score-based methodology (inverse probability of treatment weighting), we compared patients having received barbiturates within the first 24 hours of admission (barbiturates group) and those who did not (control group). We used cause-specific Cox models for ICU survival and risk of VAP, and logistic regression for the 3-month Glasgow Outcome Scale (GOS) evaluation. Among the 1396 patients with severe trauma, 383 had intracranial hypertension on admission and were analyzed. Among them, 96 (25.1%) received barbiturates. The early use of barbiturates was significantly associated with increased ICU mortality (HR = 1.85, 95%CI 1.03–3.33). However, barbiturates treatment was not significantly associated with VAP (HR = 1.02, 95%CI 0.75–1.41) or 3-month GOS (OR = 1.67, 95%CI 0.84–3.33). Regarding the absence of relevant clinical trials, our results suggest that each early prescription of barbiturates requires a careful assessment of the benefit/risk ratio. Public Library of Science 2022-05-04 /pmc/articles/PMC9067881/ /pubmed/35507627 http://dx.doi.org/10.1371/journal.pone.0268013 Text en © 2022 Léger et al https://creativecommons.org/licenses/by/4.0/This is an open access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Research Article
Léger, Maxime
Frasca, Denis
Roquilly, Antoine
Seguin, Philippe
Cinotti, Raphaël
Dahyot-Fizelier, Claire
Asehnoune, Karim
Le Borgne, Florent
Gaillard, Thomas
Foucher, Yohann
Lasocki, Sigismond
Early use of barbiturates is associated with increased mortality in traumatic brain injury patients from a propensity score-based analysis of a prospective cohort
title Early use of barbiturates is associated with increased mortality in traumatic brain injury patients from a propensity score-based analysis of a prospective cohort
title_full Early use of barbiturates is associated with increased mortality in traumatic brain injury patients from a propensity score-based analysis of a prospective cohort
title_fullStr Early use of barbiturates is associated with increased mortality in traumatic brain injury patients from a propensity score-based analysis of a prospective cohort
title_full_unstemmed Early use of barbiturates is associated with increased mortality in traumatic brain injury patients from a propensity score-based analysis of a prospective cohort
title_short Early use of barbiturates is associated with increased mortality in traumatic brain injury patients from a propensity score-based analysis of a prospective cohort
title_sort early use of barbiturates is associated with increased mortality in traumatic brain injury patients from a propensity score-based analysis of a prospective cohort
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9067881/
https://www.ncbi.nlm.nih.gov/pubmed/35507627
http://dx.doi.org/10.1371/journal.pone.0268013
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