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Critical Care
Published in: Critical Care 1/2017

Open Access 01-12-2017 | Research

Association between continuous hyperosmolar therapy and survival in patients with traumatic brain injury – a multicentre prospective cohort study and systematic review

Authors: Karim Asehnoune, Sigismond Lasocki, Philippe Seguin, Thomas Geeraerts, Pierre François Perrigault, Claire Dahyot-Fizelier, Catherine Paugam Burtz, Fabrice Cook, Dominique Demeure dit latte, Raphael Cinotti, Pierre Joachim Mahe, Camille Fortuit, Romain Pirracchio, Fanny Feuillet, Véronique Sébille, Antoine Roquilly, For the ATLANREA group, For the COBI group

Published in: Critical Care | Issue 1/2017

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Abstract

Background

Intracranial hypertension (ICH) is a major cause of death after traumatic brain injury (TBI). Continuous hyperosmolar therapy (CHT) has been proposed for the treatment of ICH, but its effectiveness is controversial. We compared the mortality and outcomes in patients with TBI with ICH treated or not with CHT.

Methods

We included patients with TBI (Glasgow Coma Scale ≤ 12 and trauma-associated lesion on brain computed tomography (CT) scan) from the databases of the prospective multicentre trials Corti-TC, BI-VILI and ATLANREA. CHT consisted of an intravenous infusion of NaCl 20% for 24 hours or more. The primary outcome was the risk of survival at day 90, adjusted for predefined covariates and baseline differences, allowing us to reduce the bias resulting from confounding factors in observational studies. A systematic review was conducted including studies published from 1966 to December 2016.

Results

Among the 1086 included patients, 545 (51.7%) developed ICH (143 treated and 402 not treated with CHT). In patients with ICH, the relative risk of survival at day 90 with CHT was 1.43 (95% CI, 0.99–2.06, p = 0.05). The adjusted hazard ratio for survival was 1.74 (95% CI, 1.36–2.23, p < 0.001) in propensity-score-adjusted analysis. At day 90, favourable outcomes (Glasgow Outcome Scale 4–5) occurred in 45.2% of treated patients with ICH and in 35.8% of patients with ICH not treated with CHT (p = 0.06). A review of the literature including 1304 patients from eight studies suggests that CHT is associated with a reduction of in-ICU mortality (intervention, 112/474 deaths (23.6%) vs. control, 244/781 deaths (31.2%); OR 1.42 (95% CI, 1.04–1.95), p = 0.03, I2 = 15%).

Conclusions

CHT for the treatment of posttraumatic ICH was associated with improved adjusted 90-day survival. This result was strengthened by a review of the literature.
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Metadata
Title
Association between continuous hyperosmolar therapy and survival in patients with traumatic brain injury – a multicentre prospective cohort study and systematic review
Authors
Karim Asehnoune
Sigismond Lasocki
Philippe Seguin
Thomas Geeraerts
Pierre François Perrigault
Claire Dahyot-Fizelier
Catherine Paugam Burtz
Fabrice Cook
Dominique Demeure dit latte
Raphael Cinotti
Pierre Joachim Mahe
Camille Fortuit
Romain Pirracchio
Fanny Feuillet
Véronique Sébille
Antoine Roquilly
For the ATLANREA group
For the COBI group
Publication date
01-12-2017
Publisher
BioMed Central
Published in
Critical Care / Issue 1/2017
Electronic ISSN: 1364-8535
DOI
https://doi.org/10.1186/s13054-017-1918-4

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