Review article: Prehospital fluid management in traumatic brain injury

Tan, Pek Ghe; Cincotta, Marion; Clavisi, Ornella; Bragge, Peter; Wasiak, Jason; Pattuwage, Loyal; Gruen, Russell L.

doi:10.1111/j.1742-6723.2011.01455.x

Cited by 39 publications

(26 citation statements)

References 23 publications

(77 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…No studies have reported better survival and functional outcomes over the use of isotonic crystalloids. [30] Further to this, a multicenter randomized control trial (RCT) of 1087 patients (15 years or older with blunt trauma who did not meet the criteria for hypovolemic shock) with severe TBI (GCS 8 or less) showed that even the initial resuscitation with hypertonic saline or hypertonic saline/dextran, compared with normal saline, were found to be comparable in terms of 6-month neurologic outcome or survival. [31] However, this study was terminated by the data and safety monitoring board after randomization of 1331 patients.…”

Section: Methodsmentioning

confidence: 99%

Pre-hospital and initial management of head injury patients: An update

et al. 2014

View full text Add to dashboard Cite

Background:Most of the bad outcomes in patients with severe traumatic brain injury (TBI) are related to the presence of a high incidence of pre-hospital secondary brain insults. Therefore, knowledge of these variables and timely management of the disease at the pre-hospital period can significantly improve the outcome and decrease the mortality. The Brain Trauma Foundation guideline on “Prehospital Management” published in 2008 could provide the standardized protocols for the management of patients with TBI; however, this guideline has included the relevant papers up to 2006.Methods:A PubMed search for relevant clinical trials and reviews (from 1 January 2007 to 31 March 2013), which specifically discussed about the topic, was conducted.Results:Based on the evidence, majority of the management strategies comprise of rapid correction of hypoxemia and hypotension, the two most important predictors for mortality. However, there is still a need to define the goals for the management of hypotension and inclusion of newer difficult airway carts as well as proper monitoring devices for ensuring better intubation and ventilatory management. Isotonic saline should be used as the first choice for fluid resuscitation. The pre-hospital hypothermia has more adverse effects; therefore, this should be avoided.Conclusion:Most of the management trials published after 2007 have focused mainly on the treatment as well as the prevention strategies for secondary brain injury. The results of these trials would be certainly adopted by new standardized guidelines and therefore may have a substantial impact on the pre-hospital management in patients with TBI.

show abstract

Section: Methodsmentioning

confidence: 99%

Pre-hospital and initial management of head injury patients: An update

et al. 2014

View full text Add to dashboard Cite

show abstract

“…These studies have not consistently shown a benefit for hypertonic solutions. [16][17][18] No randomized controlled clinical trials directly comparing the pre-hospital use of LR and NS in injured patients have been conducted to date.…”

mentioning

confidence: 99%

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

“…However, recent clinical trials have failed to demonstrate the superior efficacy of HTS over other fluid resuscitation strategies [23]–[25]. The heterogeneity in the trial designs, treatment regimen, read-outs, and the low number of patients enrolled for each study have precluded a definitive consensus and the debate remains largely open.…”

Section: Discussionmentioning

confidence: 99%

Hypertonic Saline Reduces Vascular Leakage in a Mouse Model of Severe Dengue

Tan

et al. 2013

PLoS ONE

View full text Add to dashboard Cite

Dengue (DEN) is a mosquito-borne viral disease and represents a serious public health threat and an economical burden throughout the tropics. Dengue clinical manifestations range from mild acute febrile illness to severe DEN hemorrhagic fever/DEN shock syndrome (DHF/DSS). Currently, resuscitation with large volumes of isotonic fluid remains the gold standard of care for DEN patients who develop vascular leakage and shock. Here, we investigated the ability of small volume of hypertonic saline (HTS) suspensions to control vascular permeability in a mouse model of severe DEN associated with vascular leakage. Several HTS treatment regimens were considered and our results indicated that a single bolus of 7.5% NaCl at 4 mL per kg of body weight administered at the onset of detectable vascular leakage rapidly and significantly reduced vascular leak for several days after injection. This transient reduction of vascular leakage correlated with reduced intestine and liver damage with restoration of the hepatic functions, and resulted in delayed death of the infected animals. Mechanistically, we showed that HTS did not directly impact on the viral titers but resulted in lower immune cells counts and decreased systemic levels of soluble mediators involved in vascular permeability. In addition, we demonstrated that neutrophils do not play a critical role in DEN-associated vascular leakage and that the therapeutic effect of HTS is not mediated by its impact on the neutrophil counts. Together our data indicate that HTS treatment can transiently but rapidly reduce dengue-associated vascular leakage, and support the findings of a recent clinical trial which evaluated the efficacy of a hypertonic suspension to impact on vascular permeability in DSS children.

show abstract

Review article: Prehospital fluid management in traumatic brain injury

Cited by 39 publications

References 23 publications

Pre-hospital and initial management of head injury patients: An update

Pre-hospital and initial management of head injury patients: An update

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

Hypertonic Saline Reduces Vascular Leakage in a Mouse Model of Severe Dengue

Contact Info

Product

Resources

About