Department of Neurology & Neurological Surgery, Cornell University Joan and Sanford I Weill Medical College, 525 East 68 street, F-610, New York, NY, 10065, USA.
Crit Care. 2018 Feb 20;22(1):37. doi: 10.1186/s13054-018-1963-7.
Traumatic brain injury (TBI) remains a major cause of mortality and disability. Post-traumatic intracranial hypertension (ICH) further complicates the care of patients. Hyperosmolar agents are recommended for the treatment of ICH, but no consensus or high-level data exist on the use of any particular agent or the route of administration. The two agents used commonly are hypertonic saline (HTS) and mannitol given as bolus therapy. Smaller studies suggest that HTS may be a superior agent in reducing the ICH burden, but neither agent has been shown to improve mortality or functional outcome. In a recently published analysis of pooled data from three prospective clinical trials, continuous infusion of HTS correlated with serum hypernatremia and reduced ICH burden in addition to improving 90-day mortality and functional outcome. This lays the foundation for the upcoming continuous hyperosmolar therapy for traumatic brain-injured patients (COBI) randomized controlled trial to study the outcome benefit of continuous HTS infusion to treat ICH after severe TBI. This is much anticipated and will be a high impact trial should the results be replicated. However, this would still leave a question over the use of mannitol bolus therapy which will need to be studied.
创伤性脑损伤（TBI）仍然是导致死亡和残疾的主要原因。创伤后颅内高压（ICH）进一步使患者的治疗复杂化。高渗剂被推荐用于 ICH 的治疗，但目前还没有关于任何特定药物或给药途径的共识或高级别数据。常用的两种药物是高渗盐水（HTS）和甘露醇，以推注疗法给药。较小的研究表明，HTS 可能是减轻 ICH 负担的更好药物，但两种药物均未显示能改善死亡率或功能预后。在最近发表的一项对三项前瞻性临床试验的汇总数据分析中，HTS 的连续输注与血清高钠血症相关，并减轻 ICH 负担，此外还改善了 90 天死亡率和功能预后。这为即将进行的创伤性脑损伤患者连续高渗治疗（COBI）随机对照试验奠定了基础，该试验旨在研究连续 HTS 输注治疗严重 TBI 后 ICH 的疗效。如果结果得到复制，这将是一项备受期待的高影响力试验。然而，这仍将留下一个关于甘露醇推注治疗的问题，需要对其进行研究。
