Maguigan Kelly L, Dennis Bradley M, Hamblin Susan E, Guillamondegui Oscar D
Department of Pharmaceutical Services, Vanderbilt University Medical Center, Nashville, TN 1211 Medical Center Drive, B131 VUH, Nashville, TN 37232, United States.
Department of Trauma and Surgical Critical Care, Vanderbilt University Medical Center, Nashville, TN 1211 21st Avenue South, 404 Medical Arts Building, Nashville, TN 37232, United States.
J Clin Neurosci. 2017 May;39:147-150. doi: 10.1016/j.jocn.2017.01.025. Epub 2017 Feb 15.
Hypertonic saline (HTS) is an effective therapy for reducing intracranial pressure (ICP). The ideal method of administration is unknown. The purpose of this study was to evaluate the method of HTS infusion and time to goal osmolality. A retrospective cohort analysis was conducted in severe TBI patients with ICP monitoring in place who received 2 doses of HTS. Patients were divided into bolus versus continuous infusion HTS cohorts. The primary outcome was median time to goal osmolality. Secondary outcomes included percentage of patients reaching goal osmolality, percent time at goal osmolality, mean cerebral perfusion pressure (CPP) and ICP, ICU length of stay, and mortality. Safety outcomes included rates of hyperchloremia, hypernatremia, and acute kidney injury (AKI). 162 patients were included with similar baseline characteristics. Time to goal osmolality was similar between cohorts (bolus 9.78h vs. continuous 11.4h, p=0.817). A significant difference in the percentage of patients reaching goal osmolality favoring the continuous group was found (93.9% vs 73.3%, p=0.003). The continuous group was maintained at goal osmolality for a higher percentage of osmolality values after reaching goal (80% vs. 50%, p=0.032). No difference was seen in CPP, ICP, length of stay and mortality. Rates of hypernatremia were similar, but significant higher rates of hyperchloremia (0.77vs 1.58 events per HTS days, p<0.001) and AKI (0% vs 12.9%, p=0.025) were observed in the continuous cohort. Although no difference in time to goal osmolality was observed, continuous HTS was associated with a higher percentage of patients achieving goal osmolality.
高渗盐水（HTS）是降低颅内压（ICP）的一种有效疗法。理想的给药方法尚不清楚。本研究的目的是评估HTS输注方法及达到目标渗透压的时间。对有ICP监测且接受2剂HTS的重度创伤性脑损伤（TBI）患者进行了回顾性队列分析。患者被分为HTS推注组和持续输注组。主要结局是达到目标渗透压的中位时间。次要结局包括达到目标渗透压的患者百分比、处于目标渗透压的时间百分比、平均脑灌注压（CPP）和ICP、重症监护病房（ICU）住院时间及死亡率。安全性结局包括高氯血症、高钠血症和急性肾损伤（AKI）的发生率。纳入了162例具有相似基线特征的患者。两组达到目标渗透压的时间相似（推注组9.78小时 vs. 持续输注组11.4小时，p = 0.817）。发现达到目标渗透压的患者百分比在持续输注组更具优势，存在显著差异（93.9% vs 73.3%，p = 0.003）。持续输注组在达到目标后处于目标渗透压的时间百分比更高（80% vs. 50%，p = 0.032）。CPP、ICP、住院时间和死亡率方面未见差异。高钠血症发生率相似，但持续输注组的高氯血症发生率显著更高（每HTS治疗日0.77次 vs 1.58次，p < 0.001），AKI发生率也更高（0% vs 12.9%，p = 0.025）。尽管达到目标渗透压的时间未见差异，但持续输注HTS与更高比例的患者实现目标渗透压相关。
