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

Carole Ichai, Jean François Payen, Jean Christophe Orban, Hervé Quintard, Hubert Roth, Robin Legrand, Gilles Francony, Xavier M. Leverve

Research output: Contribution to journalArticlepeer-review

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.

Original languageEnglish (US)
Pages (from-to)1413-1422
Number of pages10
JournalIntensive Care Medicine
Volume39
Issue number8
DOIs
StatePublished - Aug 2013

Keywords

  • Intracranial hypertension
  • Intracranial pressure
  • Lactate solution
  • Osmotherapy
  • Traumatic brain injury

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

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