1. Association between continuous hyperosmolar therapy and survival in patients with traumatic brain injury – a multicentre prospective cohort study and systematic review
- Author
-
Asehnoune, Karim, Lasocki, Sigismond, Seguin, Philippe, Geeraerts, Thomas, Perrigault, Pierre François, Dahyot-Fizelier, Claire, Paugam Burtz, Catherine, Cook, Fabrice, Demeure dit latte, Dominique, Cinotti, Raphael, Mahe, Pierre Joachim, Fortuit, Camille, Pirracchio, Romain, Feuillet, Fanny, Sébille, Véronique, Roquilly, Antoine, For the ATLANREA group, and For the COBI group
- Subjects
Biomedical and Clinical Sciences ,Clinical Sciences ,Clinical Research ,Traumatic Brain Injury (TBI) ,Traumatic Head and Spine Injury ,Neurosciences ,Brain Disorders ,Physical Injury - Accidents and Adverse Effects ,Evaluation of treatments and therapeutic interventions ,6.1 Pharmaceuticals ,Good Health and Well Being ,Adult ,Female ,Humans ,Male ,Middle Aged ,Brain Injuries ,Traumatic ,Cohort Studies ,Glasgow Coma Scale ,Intracranial Hypertension ,Propensity Score ,Prospective Studies ,Retrospective Studies ,Saline Solution ,Hypertonic ,Survival Analysis ,Tomography ,X-Ray Computed ,Trauma ,Traumatic brain injury ,Intracranial hypertension ,Brain oedema ,Hyperosmolar therapy ,Saline solution ,Hypertonic ,Sodium ,ATLANREA group ,COBI group ,Medical and Health Sciences ,Emergency & Critical Care Medicine ,Biomedical and clinical sciences ,Health sciences - Abstract
BackgroundIntracranial hypertension (ICH) is a major cause of death after traumatic brain injury (TBI). Continuous hyperosmolar therapy (CHT) has been proposed for the treatment of ICH, but its effectiveness is controversial. We compared the mortality and outcomes in patients with TBI with ICH treated or not with CHT.MethodsWe included patients with TBI (Glasgow Coma Scale ≤ 12 and trauma-associated lesion on brain computed tomography (CT) scan) from the databases of the prospective multicentre trials Corti-TC, BI-VILI and ATLANREA. CHT consisted of an intravenous infusion of NaCl 20% for 24 hours or more. The primary outcome was the risk of survival at day 90, adjusted for predefined covariates and baseline differences, allowing us to reduce the bias resulting from confounding factors in observational studies. A systematic review was conducted including studies published from 1966 to December 2016.ResultsAmong the 1086 included patients, 545 (51.7%) developed ICH (143 treated and 402 not treated with CHT). In patients with ICH, the relative risk of survival at day 90 with CHT was 1.43 (95% CI, 0.99-2.06, p = 0.05). The adjusted hazard ratio for survival was 1.74 (95% CI, 1.36-2.23, p
- Published
- 2017