Half-molar sodium lactate infusion to prevent intracranial hypertensive episodes in severe traumatic brain injured patients: a randomized controlled trial.

Abstract

PURPOSE:

Preventive treatments of traumatic intracranial hypertension are not yet established. We aimed to compare the efficiency of half-molar sodium lactate (SL) versus saline serum solutions in preventing episodes of raised intracranial pressure (ICP) in patients with severe traumatic brain injury (TBI).

METHODS:

This was a double-blind, randomized controlled trial including 60 patients with severe TBI requiring ICP monitoring. Patients were randomly allocated to receive a 48-h continuous infusion at 0.5 ml/kg/h of either SL (SL group) or isotonic saline solution (control group) within the first 12 h post-trauma. Serial measurements of ICP, as well as fluid, sodium, and chloride balance were performed over the 48-h study period. The primary outcome was the number of raised ICP (≥20 mmHg) requiring a specific treatment.

RESULTS:

Raised ICP episodes were reduced in the SL group as compared to the control group within the 48-h study period: 23 versus 53 episodes, respectively (p < 0.05). The proportion of patients presenting raised ICP episodes was smaller in the SL group than in the saline group: 11 (36 %) versus 20 patients (66 %) (p < 0.05). Cumulative 48-h fluid and chloride balances were reduced in the SL group compared to the control group (both p < 0.01).

CONCLUSION:

A 48-h infusion of SL decreased the occurrence of raised ICP episodes in patients with severe TBI, while reducing fluid and chloride balances. These findings suggest that SL solution could be considered as an alternative treatment to prevent raised ICP following severe TBI.

• Authors: Carole Ichai, Jean-François Payen, Jean-Christophe Orban, Hervé Quintard, Hubert Roth, Robin Legrand, Gilles Francony, Xavier M Leverve
• Journal: Intensive care medicine (Intensive Care Med) Vol. 39 Issue 8 Pg. 1413-22 (Aug 2013) ISSN: 1432-1238 [Electronic] United States
• PMID: 23749153 (Publication Type: Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)

Chemical References

• Chlorides
• Sodium
• Sodium Lactate

Topics

• Adolescent
• Adult
• Aged
• Body Fluids
• Brain Injuries (complications, metabolism)
• Chlorides (metabolism)
• Double-Blind Method
• Female
• Humans
• Infusions, Intravenous
• Injury Severity Score
• Intracranial Hypertension (etiology, metabolism, prevention & control)
• Male
• Middle Aged
• Prospective Studies
• Sodium (metabolism)
• Sodium Lactate (administration & dosage)
• Young Adult