A prospective, randomized, and controlled study of fluid management in children with severe head injury

Simma, Burkhard; Burger, R.; Falk, Markus; Sacher, Peter; Fanconi, Sergio

doi:10.1097/00008506-199904000-00019

Cited by 27 publications

(43 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…In addition, they observed that fewer interventions, fewer complications, and a shorter time in intensive care were associated with hypertonic saline use. 37 From the results of the current study, we conclude that inducing moderate hypernatremia with 30% hypertonic saline can decrease ICP relative to baseline and reduce the incidence of clinically significant IH in patients with ALF. Larger trials are required to determine whether this simple intervention reduces the incidence of cerebral death or improves intensive care or hospital survival results.…”

Section: Discussionsupporting

confidence: 52%

“…Hypernatremia induced with 3% saline in patients with resistant IH results in a significant reduction in ICP and an increase in cerebral perfusion pressure. 36 Simma et al 37 performed a randomized controlled clinical trial investigating fluid therapy in pediatric head trauma. They compared hypertonic saline with lactated Ringer's maintenance fluid and concluded that hypertonic saline was superior in the management of severe head injury.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

The effect of hypertonic sodium chloride on intracranial pressure in patients with acute liver failure

et al. 2004

View full text Add to dashboard Cite

Acute liver failure (ALF) is a rare condition characterized by the development of encephalopathy in the absence of chronic liver disease. Cerebral edema occurs in up to 80% of patients with Grade IV encephalopathy. In the current prospective randomized controlled clinical trial, we examined the effect of induced hypernatremia on the incidence of intracranial hypertension (IH) in patients with ALF. Thirty patients with ALF and Grade III or IV encephalopathy were randomized. Patients in Group 1 (n ‫؍‬ 15) received the normal standard of care. Patients in Group 2 (n ‫؍‬ 15) received standard care and hypertonic saline (30%) via infusion to maintain serum sodium levels of 145-155 mmol/L. Intracranial pressure (ICP) was monitored in all patients with a subdural catheter (Camino Systems, San Diego, CA) for up to 72 hours after inclusion. Serum sodium levels became significantly different from the levels observed in the control group at 6 hours (P < .01). Over the first 24 hours, norepinephrine dose increased relative to baseline in the control group (P < .001; 13 patients) but not in the treatment group. ICP decreased significantly relative to baseline over the first 24 hours in the treatment group (P ‫؍‬ .003; 13 patients) but not in the control group. The incidence of IH, defined as a sustained increase in ICP to a level of 25 mm Hg or greater, was significantly higher in the control group (P ‫؍‬ .04). In conclusion, induction and maintenance of hypernatremia can reduce the incidence and severity of IH in patients presenting with ALF. (HEPATOLOGY 2004;39:464 -470.)

show abstract

Section: Discussionsupporting

confidence: 52%

Section: Discussionmentioning

confidence: 99%

The effect of hypertonic sodium chloride on intracranial pressure in patients with acute liver failure

et al. 2004

View full text Add to dashboard Cite

show abstract

“…20 One clinical study randomized brain-injured children to receive either LR or hypertonic saline as the main resuscitation fluid during the first 72 h of hospitalization. 24 In this study, the LR group required a greater number of interventions to decrease ICP, but clinical outcomes were unchanged. In another randomized clinical trial in which brain-injured patients were administered either 250 mL LR or hypertonic saline prior to hospital arrival, no significant differences in mortality or neurological outcome were observed.…”

mentioning

confidence: 67%

The Impact of Pre-Hospital Administration of Lactated Ringer's Solution versus Normal Saline in Patients with Traumatic Brain Injury

Rowell

Fair

Barbosa

et al. 2016

Journal of Neurotrauma

View full text Add to dashboard Cite

Lactated Ringer's (LR) and normal saline (NS) are both used for resuscitation of injured patients. NS has been associated with increased resuscitation volume, blood loss, acidosis, and coagulopathy compared with LR. We sought to determine if pre-hospital LR is associated with improved outcome compared with NS in patients with and without traumatic brain injury (TBI). We included patients receiving pre-hospital LR or NS from the PRospective Observational Multicenter Major Trauma Transfusion (PROMMTT) study. Patients with TBI (Abbreviated Injury Scale [AIS] head ‡3) and without TBI (AIS head £2) were compared. Cox proportional hazards models including Injury Severity Score (ISS), AIS head, AIS extremity, age, fluids, intubation status, and hospital site were generated for prediction of mortality. Linear regression models were generated for prediction of red blood cell (RBC) and crystalloid requirement, and admission biochemical/ physiological parameters. Seven hundred ninety-one patients received either LR (n = 117) or NS (n = 674). Median ISS, AIS head, AIS extremity, and pre-hospital fluid volume were higher in TBI and non-TBI patients receiving LR compared with NS ( p < 0.01). In patients with TBI (n = 308), LR was associated with higher adjusted mortality compared with NS (hazard rate [HR] = 1.78, confidence interval [CI] 1.04-3.04, p = 0.035). In patients without TBI (n = 483), no difference in mortality was demonstrated (HR = 1.49, CI 0.757-2.95, p = 0.247). Fluid type had no effect on admission biochemical or physiological parameters, 6-hour RBC, or crystalloid requirement in either group. LR was associated with increased mortality compared with NS in patients with TBI. These results underscore the need for a prospective randomized trial comparing pre-hospital LR with NS in patients with TBI.

show abstract

“…Shackford et al [59] noted that HTS was associated with a favourable fluid balance and control of intracranial pressure. Simma et al [60] also found HTS advantageous in the treatment of head-injured children and reported improved outcomes including fewer interventions necessary to keep ICP ≤ 15 mm Hg, shorter ICU length of stay, and fewer days of mechanical ventilation compared to their standard approach. Furthermore, they also noted umbrella effect benefits including a reduced incidence of ARDS, pneumonia, sepsis and arrhythmias.…”

Section: Hts In Traumatic Brain Injuries (Tbi)mentioning

confidence: 99%

Role of permissive hypotension, hypertonic resuscitation and the global increased permeability syndrome in patients with severe hemorrhage: adjuncts to damage control resuscitation to prevent intra-abdominal hypertension

Duchesne¹,

Kaplan²,

Balogh³

et al. 2015

Anaesthesiol Intensive Ther

View full text Add to dashboard Cite

Secondary intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) are closely related to fluid resuscitation. IAH causes major deterioration of the cardiac function by affecting preload, contractility and afterload. The aim of this review is to discuss the different interactions between IAH, ACS and resuscitation, and to explore a new hypothesis with regard to damage control resuscitation, permissive hypotension and global increased permeability syndrome. The recognition of the association between the development of ACS and resuscitation urged the need for new approach in traumatic shock management. Over a decade after wide spread application of damage control surgery damage control resuscitation was developed. DCR differs from previous resuscitation approaches by attempting an earlier and more aggressive correction of coagulopathy, as well as metabolic derangements like acidosis and hypothermia, often referred to as the 'deadly triad' or the 'bloody vicious cycle' . Permissive hypotension involves keeping the blood pressure low enough to avoid exacerbating uncontrolled haemorrhage while maintaining perfusion to vital end organs. The potential detrimental mechanisms of early, aggressive crystalloid resuscitation have been described. Limitation of fluid intake by using colloids, hypertonic saline (HTS) or hyperoncotic albumin solutions have been associated with favourable effects. HTS allows not only for rapid restoration of circulating intravascular volume with less administered fluid, but also attenuates post-injury oedema at the microcirculatory level and may improve microvascular perfusion. Capillary leak represents the maladaptive, often excessive, and undesirable loss of fluid and electrolytes with or without protein into the interstitium that generates oedema. The global increased permeability syndrome (GIPS) has been articulated in patients with persistent systemic inflammation failing to curtail transcapillary albumin leakage and resulting in increasingly positive net fluid balances. GIPS may represent a third hit after the initial insult and the ischaemia reperfusion injury. Novel markers like the capillary leak index, extravascular lung water and pulmonary permeability index may help the clinician in guiding appropriate fluid management. Capillary leak is an inflammatory condition with diverse triggers that results from a common pathway that includes ischaemia-reperfusion, toxic oxygen metabolite generation, cell wall and enzyme injury leading to a loss of capillary endothelial barrier function. Fluid overload should be avoided in this setting.

show abstract

A prospective, randomized, and controlled study of fluid management in children with severe head injury

Cited by 27 publications

References 0 publications

The effect of hypertonic sodium chloride on intracranial pressure in patients with acute liver failure

The effect of hypertonic sodium chloride on intracranial pressure in patients with acute liver failure

The Impact of Pre-Hospital Administration of Lactated Ringer's Solution versus Normal Saline in Patients with Traumatic Brain Injury

Role of permissive hypotension, hypertonic resuscitation and the global increased permeability syndrome in patients with severe hemorrhage: adjuncts to damage control resuscitation to prevent intra-abdominal hypertension

Contact Info

Product

Resources

About