Department of Health Statistics, Naval Medical University, No. 800 Xiangyin Road, Shanghai, 200433, China.
Department of Vascular and Endovascular Surgery, Hainan Hospital of PLA General Hospital, Sanya, 572000, China.
Neurosurg Rev. 2024 Feb 10;47(1):78. doi: 10.1007/s10143-024-02316-0.
Osmotic therapy has been recognized as an important treatment option for patients with traumatic brain injury (TBI). Nevertheless, the effect of hypertonic saline (HTS) remains unknown, as findings are primarily based on a large database. This study aimed to elucidate the effect of HTS on the clinical outcomes of patients with TBI admitted to the intensive care unit (ICU). We retrospectively identified patients with moderate-to-severe TBI from two public databases: Medical Information Mart for Intensive Care (MIMIC)-IV and eICU Collaborative Research Database (eICU-CRD). A marginal structural Cox model (MSCM) was used, with time-dependent variates designed to reflect exposure over time during ICU stay. Trajectory modeling based on the intracranial pressure evolution pattern allowed for the identification of subgroups. Overall, 130 (6.65%) of 1955 eligible patients underwent HTS. MSCM indicated that the HTS significantly associated with higher infection complications (e.g., urinary tract infection (HR 1.88, 95% CI 1.26-2.81, p = 0.002)) and increased ICU LOS (HR 2.02, 95% CI 1.71-2.40, p < 0.001). A protective effect of HTS on GCS was found in subgroups with medium and low intracranial pressure. Our study revealed no significant difference in mortality between patients who underwent HTS and those who did not. Increased occurrence rates of infection and electrolyte imbalance are inevitable outcomes of continuous HTS infusion. Although the study suggests slight beneficial effects, including better neurological outcomes, these results warrant further validation.
渗透性治疗已被认为是创伤性脑损伤（TBI）患者的重要治疗选择。然而，高渗盐水（HTS）的效果仍不清楚，因为这些发现主要基于大型数据库。本研究旨在阐明 HTS 对入住重症监护病房（ICU）的 TBI 患者临床结局的影响。我们从两个公共数据库：医疗信息集市重症监护（MIMIC-IV）和 eICU 协作研究数据库（eICU-CRD）中回顾性地确定了中度至重度 TBI 患者。使用边缘结构 Cox 模型（MSCM），时间相关变量旨在反映 ICU 住院期间随时间的暴露情况。基于颅内压演变模式的轨迹建模允许识别亚组。总体而言，1955 名符合条件的患者中有 130 名（6.65%）接受了 HTS。MSCM 表明 HTS 与更高的感染并发症显著相关（例如，尿路感染（HR 1.88，95%CI 1.26-2.81，p=0.002）和 ICU LOS 增加（HR 2.02，95%CI 1.71-2.40，p<0.001）。在中低颅内压亚组中发现 HTS 对 GCS 有保护作用。我们的研究表明，接受 HTS 和未接受 HTS 的患者之间的死亡率没有显著差异。连续 HTS 输注不可避免地会增加感染和电解质失衡的发生率。尽管该研究表明存在轻微的有益效果，包括更好的神经功能结局，但这些结果需要进一步验证。
