Out-of-Hospital Hypertonic Resuscitation Following Severe Traumatic Brain Injury

Abstract

RAUMATIC BRAIN INJURY (TBI) IS the leading cause of death following blunt trauma, and survivors often sustain severe disability. TBI is responsible for the greatest number of potential years of life lost from any cause and carries the highest burden on loss of quality-adjusted life-years among survivors. 1 The primary injury to the brain occurs at the time of impact; however, subsequent compromise of cerebral perfusion can lead to an ischemic insult that extends the primary injury, creating a secondary brain injury. 2 Current therapy following severe TBI is focused on minimizing secondary injury by supporting systemic perfusion and reducing intracranial pressure Author Affiliations are listed at the end of this article.

Hypertonic saline in severe traumatic brain injury: a systematic review and meta-analysis of randomized controlled trials

“…[27][28][29][30][31][32][33][34][35][36][37] All studies were published in English. Of the 11 studies, only 3 included more than 100 patients 27,31,32 ( Table 1).…”

“…All studies specified adult population; however, three studies defined adult population as 16 years of age and older, 27,30,33 and one study as 15 years of age and older. 31 One study randomized intracranial hypertension episodes, instead of randomizing patients. 30 In one study, three patients (0.01% of our total population) with stroke were also included, which represented less than 15% of that study's patient population.…”

“…30 In one study, three patients (0.01% of our total population) with stroke were also included, which represented less than 15% of that study's patient population. 34 Three comparators were identified: hyperosmolar solution (mannitol or sodium bicarbonate), 28,[33][34][35]37 iso-osmolar solution (normal saline or ringer's lactate), 27,31,32 and hypo-osmolar solution 36 (see Table 1). …”

“…In general, allocation concealment was respected in most studies (63%), 27,[30][31][32][33][34][35] and the randomization method was specified in slightly more than half of them (54%). 27,[31][32][33]35,36 In six studies (63%), the research staff, patients, and medical staff were not blinded to the intervention studied.…”

“…27,[31][32][33]35,36 In six studies (63%), the research staff, patients, and medical staff were not blinded to the intervention studied. 27,28,30,33,34,37 The information regarding blinding was missing in three studies (27%).…”