Document Detail


Osmolar therapy in pediatric traumatic brain injury.
MedLine Citation:
PMID:  21926592     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVES: To describe patterns of use for mannitol and hypertonic saline in children with traumatic brain injury, to evaluate any potential associations between hypertonic saline and mannitol use and patient demographic, injury, and treatment hospital characteristics, and to determine whether the 2003 guidelines for severe pediatric traumatic brain injury impacted clinical practice regarding osmolar therapy.
DESIGN: Retrospective cohort study.
SETTING: Pediatric Health Information System database, January, 2001 to December, 2008.
PATIENTS: Children (age <18 yrs) with traumatic brain injury and head/neck Abbreviated Injury Scale score ≥ 3 who received mechanical ventilation and intensive care.
INTERVENTIONS: : None.
MEASUREMENTS AND MAIN RESULTS: The primary outcome was hospital billing for parenteral hypertonic saline and mannitol use, by day of service. Overall, 33% (2,069 of 6,238) of the patients received hypertonic saline, and 40% (2,500 of 6,238) received mannitol. Of the 1,854 patients who received hypertonic saline or mannitol for ≥ 2 days in the first week of therapy, 29% did not have intracranial pressure monitoring. After adjustment for hospital-level variation, primary insurance payer, and overall injury severity, use of both drugs was independently associated with older patient age, intracranial hemorrhage (other than epidural), skull fracture, and higher head/neck injury severity. Hypertonic saline use increased and mannitol use decreased with publication of the 2003 guidelines, and these trends continued through 2008.
CONCLUSIONS: Hypertonic saline and mannitol are used less in infants than in older children. The patient-level and hospital-level variation in osmolar therapy use and the substantial amount of sustained osmolar therapy without intracranial pressure monitoring suggest opportunities to improve the quality of pediatric traumatic brain injury care. With limited high-quality evidence available, published expert guidelines appear to significantly impact clinical practice in this area.
Authors:
Tellen D Bennett; Kimberly D Statler; E Kent Korgenski; Susan L Bratton
Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural    
Journal Detail:
Title:  Critical care medicine     Volume:  40     ISSN:  1530-0293     ISO Abbreviation:  Crit. Care Med.     Publication Date:  2012 Jan 
Date Detail:
Created Date:  2011-12-19     Completed Date:  2012-02-15     Revised Date:  2014-09-08    
Medline Journal Info:
Nlm Unique ID:  0355501     Medline TA:  Crit Care Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  208-15     Citation Subset:  AIM; IM    
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Age Factors
Brain Injuries / drug therapy,  therapy*
Child
Child, Preschool
Female
Fluid Therapy / methods*
Humans
Infant
Infant, Newborn
Injury Severity Score
Intracranial Pressure / drug effects
Male
Mannitol / administration & dosage,  therapeutic use*
Retrospective Studies
Saline Solution, Hypertonic / therapeutic use*
Treatment Outcome
Grant Support
ID/Acronym/Agency:
1KM1CA156723/CA/NCI NIH HHS; KM1 CA156723/CA/NCI NIH HHS; KM1 CA156723-01/CA/NCI NIH HHS
Chemical
Reg. No./Substance:
0/Saline Solution, Hypertonic; 3OWL53L36A/Mannitol
Comments/Corrections
Comment In:
Crit Care Med. 2012 Jan;40(1):336-7   [PMID:  22179371 ]

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


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