Busey Kirsten, Ferreira Jason, Aldridge Petra, Crandall Marie, Johnson Donald
Department of Pharmacy, University of Florida Health Jacksonville, Jacksonville, Florida, USA.
Center for Health Equity and Quality Research, University of Florida Health Jacksonville, Jacksonville, Florida, USA.
J Emerg Trauma Shock. 2020 Oct-Dec;13(4):252-256. doi: 10.4103/JETS.JETS_66_19. Epub 2020 Dec 7.
Hypertonic saline (HTS) is a pharmacologic therapy used in patients with severe traumatic brain injuries to decrease intracranial pressure (ICP) associated with cerebral edema.
The purpose of this study was to compare ICP reduction between fixed doses of 23.4% HTS and weight-based doses.
This was a retrospective study that included adult patients at a level 1 trauma center who had nonpenetrating traumatic brain injury, an ICP monitor, and received at least one dose of 23.4% HTS.
Doses were classified as either high weight-based (>0.6 ml/kg), low weight-based (<0.6 ml/kg), or standard fixed dose (30 ml). Only doses given within 5 days post-injury were evaluated. Percent reduction in ICP was compared pre- and post-dose between dosing groups, and each dose was evaluated as a separate episode.
The primary and secondary endpoints for the study were analyzed using mixed-model, repeated-measures analysis of covariance.
A total of 97 doses of HTS were evaluated. The primary endpoint of ICP reduction showed a 42.5% decrease in ICP after the administration of a high weight-based dose, a 36.7% reduction after a low weight-based dose, and a 31.5% reduction after a fixed dose. There was no significant relationship between dose group and percent change in ICP ( = 0.25). A sub-analysis of doses received within 48 h postinjury found a significant relationship between both dose group and percent change in ICP, and initial ICP and percent change in ICP ( = 0.04, and <0.0001 respectively).
Our data did not show a significant difference between fixed- and weight-based doses of 23.4% HTS for ICP reduction.
高渗盐水（HTS）是一种用于重度创伤性脑损伤患者的药物治疗方法，以降低与脑水肿相关的颅内压（ICP）。
本研究的目的是比较固定剂量的23.4% HTS和基于体重的剂量在降低ICP方面的效果。
这是一项回顾性研究，纳入了一级创伤中心的成年患者，这些患者患有非穿透性创伤性脑损伤，有ICP监测器，并接受了至少一剂23.4% HTS。
剂量分为高体重剂量（>0.6 ml/kg）、低体重剂量（<0.6 ml/kg）或标准固定剂量（30 ml）。仅评估受伤后5天内给予的剂量。比较给药组给药前后ICP的降低百分比，每个剂量作为一个单独的事件进行评估。
使用混合模型重复测量协方差分析对研究的主要和次要终点进行分析。
共评估了97剂HTS。降低ICP的主要终点显示，高体重剂量给药后ICP降低42.5%，低体重剂量给药后降低36.7%，固定剂量给药后降低31.5%。剂量组与ICP变化百分比之间无显著关系（P = 0.25）。对受伤后48小时内接受的剂量进行的亚分析发现，剂量组与ICP变化百分比以及初始ICP与ICP变化百分比之间均存在显著关系（分别为P = 0.04和P<0.0001）。
我们的数据显示，23.4% HTS的固定剂量和基于体重的剂量在降低ICP方面没有显著差异。
