Resuscitation with Hypertonic Saline–Dextran Reduces Serum Biomarker Levels and Correlates with Outcome in Severe Traumatic Brain Injury Patients

Abstract

In the treatment of severe traumatic brain injury (TBI), the choice of fluid and osmotherapy is important. There are practical and theoretical advantages to the use of hypertonic saline. S100B, neuron-specific enolase (NSE), and myelin-basic protein (MBP) are commonly assessed biomarkers of brain injury with potential utility as diagnostic and prognostic indicators of outcome after TBI, but they have not previously been studied in the context of fluid resuscitation. This randomized controlled trial compared serum concentrations of S100B, NSE, and MBP in adult severe TBI patients resuscitated with 250 mL of 7.5% hypertonic saline plus 6% dextran70 (HSD; n = 31) versus 0.9% normal saline (NS; n = 33), and examined their relationship with neurological outcome at discharge. Blood samples drawn on admission (<or=3 h post-injury), and at 12, 24, and 48 h post-resuscitation were assayed by ELISA for the selected biomarkers. Serial comparisons of biomarker concentrations were made by ANOVA, and relationships between biomarkers and outcome were assessed by multiple regression. On admission, mean (+/-SEM) S100B and NSE concentrations were increased 60-fold (0.73 +/- 0.08 microg/L) and sevenfold (37.0 +/- 4.8 microg/L), respectively, in patients resuscitated with NS, compared to controls (0.01 +/- 0.01 and 6.2 +/- 0.6, respectively). Compared with NS resuscitation, S100B and NSE were twofold and threefold lower in HSD-treated patients and normalized within 12 h. MBP levels were not significantly different from controls in either treatment arm until 48 h post-resuscitation, when a delayed increase (0.58 +/- 0.29 microg/L) was observed in NS-treated patients. Biomarkers were elevated in the patient group showing an unfavorable outcome. HSD-resuscitated patients with favorable outcomes exhibited the lowest serum S100B and NSE concentrations, while maximal levels were found in NS-treated patients with unfavorable outcomes. The lowest biomarker levels were seen in survivors resuscitated with HSD, while maximal levels were in NS-resuscitated patients with fatal outcome. Pre-hospital resuscitation with HSD is associated with a reduction in serum S100B, NSE, and MBP concentrations, which are correlated with better outcome after severe TBI.

The Head Injury Transportation Straight to Neurosurgery (HITS-NS) randomised trial: a feasibility study

“…patients randomised directly). Five investigated interventions in head-injury, four of which fluid concerned administration 128,136,140,141 and one pre-hospital intubation. 37 The final six investigated interventions in general trauma: three fluid administration, [137][138][139] one oxygen 144 and two analgesia.…”

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

“…Two of the retrieved studies 25,26 were subgroup studies of a larger trial, 27 which was already eligible for inclusion, leaving 11 included studies. …”

Plasma B-type natriuretic peptide (BNP) variation in multi-trauma patients

“…New types of resuscitation fluids (Hypertonic saline Dextran [11], Hextend [12]) are designed to suit multi-trauma patients with traumatic brain injury, where volume resuscitation and adequate cerebral perfusion pressure has to be balanced against brain oedema exaggeration. Secondary damage prevention from reperfusion injury mandates early application of current trauma resuscitation guidelines.…”