Early Osmotherapy in Severe Traumatic Brain Injury: An International Multicenter Study

The optimal osmotic agent to treat intracranial hypertension in patients with severe traumatic brain injury (TBI) remains uncertain. We aimed to test whether the choice of mannitol or hypertonic saline (HTS) as early (first 96 h) osmotherapy in these patients might be associated with a difference in...

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Autores: Anstey, JR, Taccone, FS, Udy, AA, Citerio, G, Duranteau, J, Ichai, C, Badenes, R, Prowle, JR, Ercole, A, Oddo, M, Schneider, AG, van der Jagt, M, Wolf, S, Helbok, R, Nelson, DW, Skrifvars, MB, Harrois, A, Presneill, J, Cooper, DJ, Bailey, M, Bellomo, R, TBI Collaborative
Tipo de recurso: artículo
Estado:Versión publicada
Fecha de publicación:2019
País:España
Institución:INCLIVA
Repositorio:r-INCLIVA. Repositorio Institucional de Producción Científica de INCLIVA
OAI Identifier:oai:incliva.fundanetsuite.com:p4572
Acceso en línea:https://incliva.portalinvestigacion.com/publicaciones/4572
Access Level:acceso abierto
Palabra clave:hypertonic saline
mannitol
mortality
osmotherapy
traumatic brain injury
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spelling Early Osmotherapy in Severe Traumatic Brain Injury: An International Multicenter StudyAnstey, JRTaccone, FSUdy, AACiterio, GDuranteau, JIchai, CBadenes, RProwle, JRErcole, AOddo, MSchneider, AGvan der Jagt, MWolf, SHelbok, RNelson, DWSkrifvars, MBHarrois, APresneill, JCooper, DJBailey, MBellomo, RTBI Collaborativehypertonic salinemannitolmortalityosmotherapytraumatic brain injuryThe optimal osmotic agent to treat intracranial hypertension in patients with severe traumatic brain injury (TBI) remains uncertain. We aimed to test whether the choice of mannitol or hypertonic saline (HTS) as early (first 96 h) osmotherapy in these patients might be associated with a difference in mortality. We retrospectively analyzed data from 2015 from 14 tertiary intensive care units (ICUs) in Australia, UK, and Europe treating severe TBI patients with intracranial pressure (ICP) monitoring and compared mortality in those who received mannitol only versus HTS only. We performed multi-variable analysis adjusting for site and illness severity (Injury Severity Score, extended IMPACT score, and mean ICP over the first 96 h) using Cox proportional hazards regression. We collected data on 262 patients and compared patients who received early osmotherapy with mannitol alone (n = 46) with those who received HTS alone (n = 46). Mannitol patients were older (median age, 49.2 (19.2) vs. 40.5 (16.8) years; p = 0.02), with higher Injury Severity Scores (42 (15.9) vs. 32.1 [11.3]; p = 0.001), and IMPACT-TBI predicted 6-month mortality (34.5% [23-46] vs. 25% [13-38]; p = 0.02), but had similar APACHE-II scores, and mean and maximum ICPs over the first 96 h. The unadjusted hazard ratio for in-hospital mortality in patients receiving only mannitol was 3.35 (95% confidence interval [CI], 1.60-7.03; p = 0.001). After adjustment for key mortality predictors, the hazard ratio for in-hospital mortality in patients receiving only mannitol was 2.64 (95% CI, 0.96-7.30; p = 0.06). The choice of early osmotherapy in severe TBI patients may affect survival, or simply reflect clinician beliefs about their different roles, and warrants controlled investigation.MARY ANN LIEBERT, INC2019info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersionhttps://incliva.portalinvestigacion.com/publicaciones/4572JOURNAL OF NEUROTRAUMAISSN: 08977151ISSNe: 15579042reponame:r-INCLIVA. Repositorio Institucional de Producción Científica de INCLIVAinstname:INCLIVAInglésinfo:eu-repo/semantics/openAccessoai:incliva.fundanetsuite.com:p45722026-06-07T16:35:31Z
dc.title.none.fl_str_mv Early Osmotherapy in Severe Traumatic Brain Injury: An International Multicenter Study
title Early Osmotherapy in Severe Traumatic Brain Injury: An International Multicenter Study
spellingShingle Early Osmotherapy in Severe Traumatic Brain Injury: An International Multicenter Study
Anstey, JR
hypertonic saline
mannitol
mortality
osmotherapy
traumatic brain injury
title_short Early Osmotherapy in Severe Traumatic Brain Injury: An International Multicenter Study
title_full Early Osmotherapy in Severe Traumatic Brain Injury: An International Multicenter Study
title_fullStr Early Osmotherapy in Severe Traumatic Brain Injury: An International Multicenter Study
title_full_unstemmed Early Osmotherapy in Severe Traumatic Brain Injury: An International Multicenter Study
title_sort Early Osmotherapy in Severe Traumatic Brain Injury: An International Multicenter Study
dc.creator.none.fl_str_mv Anstey, JR
Taccone, FS
Udy, AA
Citerio, G
Duranteau, J
Ichai, C
Badenes, R
Prowle, JR
Ercole, A
Oddo, M
Schneider, AG
van der Jagt, M
Wolf, S
Helbok, R
Nelson, DW
Skrifvars, MB
Harrois, A
Presneill, J
Cooper, DJ
Bailey, M
Bellomo, R
TBI Collaborative
author Anstey, JR
author_facet Anstey, JR
Taccone, FS
Udy, AA
Citerio, G
Duranteau, J
Ichai, C
Badenes, R
Prowle, JR
Ercole, A
Oddo, M
Schneider, AG
van der Jagt, M
Wolf, S
Helbok, R
Nelson, DW
Skrifvars, MB
Harrois, A
Presneill, J
Cooper, DJ
Bailey, M
Bellomo, R
TBI Collaborative
author_role author
author2 Taccone, FS
Udy, AA
Citerio, G
Duranteau, J
Ichai, C
Badenes, R
Prowle, JR
Ercole, A
Oddo, M
Schneider, AG
van der Jagt, M
Wolf, S
Helbok, R
Nelson, DW
Skrifvars, MB
Harrois, A
Presneill, J
Cooper, DJ
Bailey, M
Bellomo, R
TBI Collaborative
author2_role author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
dc.subject.none.fl_str_mv hypertonic saline
mannitol
mortality
osmotherapy
traumatic brain injury
topic hypertonic saline
mannitol
mortality
osmotherapy
traumatic brain injury
description The optimal osmotic agent to treat intracranial hypertension in patients with severe traumatic brain injury (TBI) remains uncertain. We aimed to test whether the choice of mannitol or hypertonic saline (HTS) as early (first 96 h) osmotherapy in these patients might be associated with a difference in mortality. We retrospectively analyzed data from 2015 from 14 tertiary intensive care units (ICUs) in Australia, UK, and Europe treating severe TBI patients with intracranial pressure (ICP) monitoring and compared mortality in those who received mannitol only versus HTS only. We performed multi-variable analysis adjusting for site and illness severity (Injury Severity Score, extended IMPACT score, and mean ICP over the first 96 h) using Cox proportional hazards regression. We collected data on 262 patients and compared patients who received early osmotherapy with mannitol alone (n = 46) with those who received HTS alone (n = 46). Mannitol patients were older (median age, 49.2 (19.2) vs. 40.5 (16.8) years; p = 0.02), with higher Injury Severity Scores (42 (15.9) vs. 32.1 [11.3]; p = 0.001), and IMPACT-TBI predicted 6-month mortality (34.5% [23-46] vs. 25% [13-38]; p = 0.02), but had similar APACHE-II scores, and mean and maximum ICPs over the first 96 h. The unadjusted hazard ratio for in-hospital mortality in patients receiving only mannitol was 3.35 (95% confidence interval [CI], 1.60-7.03; p = 0.001). After adjustment for key mortality predictors, the hazard ratio for in-hospital mortality in patients receiving only mannitol was 2.64 (95% CI, 0.96-7.30; p = 0.06). The choice of early osmotherapy in severe TBI patients may affect survival, or simply reflect clinician beliefs about their different roles, and warrants controlled investigation.
publishDate 2019
dc.date.none.fl_str_mv 2019
dc.type.none.fl_str_mv info:eu-repo/semantics/article
info:eu-repo/semantics/publishedVersion
format article
status_str publishedVersion
dc.identifier.none.fl_str_mv https://incliva.portalinvestigacion.com/publicaciones/4572
url https://incliva.portalinvestigacion.com/publicaciones/4572
dc.language.none.fl_str_mv Inglés
language_invalid_str_mv Inglés
dc.rights.none.fl_str_mv info:eu-repo/semantics/openAccess
eu_rights_str_mv openAccess
dc.publisher.none.fl_str_mv MARY ANN LIEBERT, INC
publisher.none.fl_str_mv MARY ANN LIEBERT, INC
dc.source.none.fl_str_mv JOURNAL OF NEUROTRAUMA
ISSN: 08977151
ISSNe: 15579042
reponame:r-INCLIVA. Repositorio Institucional de Producción Científica de INCLIVA
instname:INCLIVA
instname_str INCLIVA
reponame_str r-INCLIVA. Repositorio Institucional de Producción Científica de INCLIVA
collection r-INCLIVA. Repositorio Institucional de Producción Científica de INCLIVA
repository.name.fl_str_mv
repository.mail.fl_str_mv
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score 15,812429

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