Document Detail


Albumin resuscitation for traumatic brain injury: is intracranial hypertension the cause of increased mortality?
MedLine Citation:
PMID:  23194432     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Mortality is higher in patients with traumatic brain injury (TBI) resuscitated with albumin compared with saline, but the mechanism for increased mortality is unknown. In patients from the Saline vs. Albumin Fluid Evaluation (SAFE) study with TBI who underwent intracranial pressure (ICP) monitoring, interventional data were collected from randomization to day 14 to determine changes in ICP (primary outcome) and in therapies used to treat increased ICP. Pattern mixture modelling, designed to address informative dropouts, was used to compare temporal changes between the albumin and saline groups, and 321 patients were identified, of whom 164 (51.1%) received albumin and 157 (48.9%) received saline. There was a significant linear increase in mean ICP and significantly more deaths in the albumin group compared with saline when ICP monitoring was discontinued during the first week (1.30±0.33 vs. -0.37±0.36, p=0.0006; and 34.4% vs. 17.4%; p=0.006 respectively), but not when monitoring ceased during the second week (-0.08±0.44 vs. -0.23±0.38, p=0.79; and 18.6% vs. 12.1%; p=0.36 respectively). There were statistically significant differences in the mean total daily doses of morphine (-0.42±0.07 vs. -0.66±0.0, p=0.0009), propofol (-0.45±0.11 vs. -0.76±0.11; p=0.034) and norepinephrine (-0.50±0.07 vs. -0.74±0.07) and in temperature (0.03±0.03 vs. 0.16±0.03; p=0.0014) between the albumin and saline groups when ICP monitoring ceased during the first week. The use of albumin for resuscitation in patients with severe TBI is associated with increased ICP during the first week. This is the most likely mechanism of increased mortality in these patients.
Authors:
D James Cooper; John Myburgh; Stephane Heritier; Simon Finfer; Rinaldo Bellomo; Laurent Billot; Lynette Murray; Shirley Vallance; ;
Publication Detail:
Type:  Journal Article; Multicenter Study; Randomized Controlled Trial; Research Support, Non-U.S. Gov't     Date:  2013-03-21
Journal Detail:
Title:  Journal of neurotrauma     Volume:  30     ISSN:  1557-9042     ISO Abbreviation:  J. Neurotrauma     Publication Date:  2013 Apr 
Date Detail:
Created Date:  2013-04-29     Completed Date:  2013-11-26     Revised Date:  2014-04-01    
Medline Journal Info:
Nlm Unique ID:  8811626     Medline TA:  J Neurotrauma     Country:  United States    
Other Details:
Languages:  eng     Pagination:  512-8     Citation Subset:  IM    
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MeSH Terms
Descriptor/Qualifier:
Adult
Albumins / therapeutic use*
Brain Injuries / drug therapy*,  mortality*
Double-Blind Method
Female
Humans
Intracranial Hypertension / etiology*,  mortality
Male
Middle Aged
Sodium Chloride / therapeutic use*
Chemical
Reg. No./Substance:
0/Albumins; 7647-14-5/Sodium Chloride
Comments/Corrections

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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