Sodium lactate versus mannitol in the treatment of intracranial hypertensive episodes in severe traumatic brain-injured patients Export

@article{citeulike:4114021, abstract = {Abstract Objectives\ \ Traumatic brain injury (TBI) is still a major cause of mortality and morbidity. Recent trials have failed to demonstrate a beneficial outcome from therapeutic treatments such as corticosteroids, hypothermia and hypertonic saline. We investigated the effect of a new hyperosmolar solution based on sodium lactate in controlling raised intracranial pressure (ICP). Design and setting\ \ Prospective open randomized study in an adult ICU. Patients\ \ Thirty-four patients with isolated severe TBI (Glasgow Coma Scale\ ≤\ 8) and intracranial hypertension were allocated to receive equally hyperosmolar and isovolumic therapy, consisting of either mannitol or sodium lactate. Rescue therapy by crossover to the alternative treatment was indicated when ICP could not be controlled. The primary endpoint was efficacy in lowering ICP after 4\ h, with a secondary endpoint of the percentage of successfully treated episodes of intracranial hypertension. The analysis was performed with both intention-to-treat and actual treatments provided. Measurements and results\ \ Compared to mannitol, the effect of the lactate solution on ICP was significantly more pronounced (7 vs. 4\ mmHg, P\ =\ 0.016), more prolonged (fourth-hour-ICP decrease: −5.9\ ±\ 1 vs. −3.2\ ±\ 0.9\ mmHg, P\ =\ 0.009) and more frequently successful (90.4 vs. 70.4\%, P\ =\ 0.053). Conclusion\ \ Acute infusion of a sodium lactate-based hyperosmolar solution is effective in treating intracranial hypertension following traumatic brain injury. This effect is significantly more pronounced than that of an equivalent osmotic load of mannitol. Additionally, in this specific group of patients, long-term outcome was better in terms of GOS in those receiving as compared to mannitol. Larger trials are warranted to confirm our findings.}, author = {Ichai, Carole and Armando, Guy and Orban, Jean-Christophe and Berthier, Frederic and Rami, Laurent and Samat-Long, Corine and Grimaud, Dominique and Leverve, Xavier}, citeulike-article-id = {4114021}, citeulike-linkout-0 = {http://dx.doi.org/10.1007/s00134-008-1283-5}, citeulike-linkout-1 = {http://view.ncbi.nlm.nih.gov/pubmed/18807008}, citeulike-linkout-2 = {http://www.hubmed.org/display.cgi?uids=18807008}, citeulike-linkout-3 = {http://www.springerlink.com/content/d311062n3541572n}, doi = {10.1007/s00134-008-1283-5}, journal = {Intensive Care Medicine}, keywords = {htic, lactate, mannitol, pic}, month = {March}, number = {3}, pages = {471--479}, posted-at = {2009-04-13 13:09:17}, priority = {0}, title = {Sodium lactate versus mannitol in the treatment of intracranial hypertensive episodes in severe traumatic brain-injured patients}, url = {http://dx.doi.org/10.1007/s00134-008-1283-5}, volume = {35}, year = {2009} }

TY - JOUR ID - citeulike:4114021 L3 - citeulike-article-id:4114021 N2 - Abstract Objectives  Traumatic brain injury (TBI) is still a major cause of mortality and morbidity. Recent trials have failed to demonstrate a beneficial outcome from therapeutic treatments such as corticosteroids, hypothermia and hypertonic saline. We investigated the effect of a new hyperosmolar solution based on sodium lactate in controlling raised intracranial pressure (ICP). Design and setting  Prospective open randomized study in an adult ICU. Patients  Thirty-four patients with isolated severe TBI (Glasgow Coma Scale ≤ 8) and intracranial hypertension were allocated to receive equally hyperosmolar and isovolumic therapy, consisting of either mannitol or sodium lactate. Rescue therapy by crossover to the alternative treatment was indicated when ICP could not be controlled. The primary endpoint was efficacy in lowering ICP after 4 h, with a secondary endpoint of the percentage of successfully treated episodes of intracranial hypertension. The analysis was performed with both intention-to-treat and actual treatments provided. Measurements and results  Compared to mannitol, the effect of the lactate solution on ICP was significantly more pronounced (7 vs. 4 mmHg, P = 0.016), more prolonged (fourth-hour-ICP decrease: −5.9 ± 1 vs. −3.2 ± 0.9 mmHg, P = 0.009) and more frequently successful (90.4 vs. 70.4%, P = 0.053). Conclusion  Acute infusion of a sodium lactate-based hyperosmolar solution is effective in treating intracranial hypertension following traumatic brain injury. This effect is significantly more pronounced than that of an equivalent osmotic load of mannitol. Additionally, in this specific group of patients, long-term outcome was better in terms of GOS in those receiving as compared to mannitol. Larger trials are warranted to confirm our findings. IS - 3 JF - Intensive Care Medicine EP - 479 TI - Sodium lactate versus mannitol in the treatment of intracranial hypertensive episodes in severe traumatic brain-injured patients VL - 35 SP - 471 KW - htic KW - lactate KW - mannitol KW - pic AU - Ichai, Carole AU - Armando, Guy AU - Orban, Jean-Christophe AU - Berthier, Frederic AU - Rami, Laurent AU - Samat-Long, Corine AU - Grimaud, Dominique AU - Leverve, Xavier PY - 2009/03/01/ UR - http://dx.doi.org/10.1007/s00134-008-1283-5 ER -