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Effect of continuous hypertonic saline infusion on clinical outcomes in patients with traumatic brain injury

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Abstract

Osmotic therapy has been recognized as an important treatment option for patients with traumatic brain injury (TBI). Nevertheless, the effect of hypertonic saline (HTS) remains unknown, as findings are primarily based on a large database. This study aimed to elucidate the effect of HTS on the clinical outcomes of patients with TBI admitted to the intensive care unit (ICU). We retrospectively identified patients with moderate-to-severe TBI from two public databases: Medical Information Mart for Intensive Care (MIMIC)-IV and eICU Collaborative Research Database (eICU-CRD). A marginal structural Cox model (MSCM) was used, with time-dependent variates designed to reflect exposure over time during ICU stay. Trajectory modeling based on the intracranial pressure evolution pattern allowed for the identification of subgroups. Overall, 130 (6.65%) of 1955 eligible patients underwent HTS. MSCM indicated that the HTS significantly associated with higher infection complications (e.g., urinary tract infection (HR 1.88, 95% CI 1.26–2.81, p = 0.002)) and increased ICU LOS (HR 2.02, 95% CI 1.71–2.40, p < 0.001). A protective effect of HTS on GCS was found in subgroups with medium and low intracranial pressure. Our study revealed no significant difference in mortality between patients who underwent HTS and those who did not. Increased occurrence rates of infection and electrolyte imbalance are inevitable outcomes of continuous HTS infusion. Although the study suggests slight beneficial effects, including better neurological outcomes, these results warrant further validation.

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Data availability

Publicly available datasets were analyzed in this study. These data can be found in the physionet (https://physionet.org/content/mimiciv/1.0/; https://physionet.org/content/eicucrd/2.0/).

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Acknowledgements

We would like to thank the Massachusetts Institute of Technology and the Beth Israel Deaconess Medical Center for the MIMIC project. We also would like to thank the Philips Eicu Research Institute and Philips Healthcare for their contribution to the Eicu-CRD project.

Funding

This study received the following funding: The San Hang Program of Naval Medical University and Clinical Research Program of Shanghai Municipal Health Commission (202340037).

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Authors and Affiliations

  1. Department of Health Statistics, Naval Medical University, No. 800 Xiangyin Road, Shanghai, 200433, China

    Chi Peng & Zhichao Jin

  2. Department of Vascular and Endovascular Surgery, Hainan Hospital of PLA General Hospital, Sanya, 572000, China

    Lijie Chi

  3. Department of Otorhinolaryngology-Head and Neck Surgery, The First Affiliated Hospital of Naval Medical University, Shanghai, 200433, China

    Mengjie Chen

  4. Department of Neurosurgery, Tangdu Hospital, Air Force Medical University (Fourth Military Medical University), Xi’an, 710038, China

    Liwei Peng

  5. Institute of Pathology and Southwest Cancer Center, Southwest Hospital, Third Military Medical University, (Army Medical University) and Key Laboratory of Tumor Immunopathology, Ministry of Education of China, Chongqing, China

    Fan Yang

  6. Department of Hematology, General Hospital Eastern Theater Command of PLA, Nanjing, 210002, China

    Liangjing Shao

  7. Department of Anesthesiology, The First Affiliated Hospital of Naval Medical University, No. 168, Changhai Road, Yangpu District, Shanghai, 200433, China

    Lulong Bo

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Contributions

FY, LJC, and LB collected, analyzed and interpreted the data regarding the tracheostomy in trauma patients. CP designed the study, and was a major contributor in writing the manuscript. MC performed the statistical analysis. LP, LS, and ZJ participated in the revision of the draft. All authors read and approved the final manuscript.

Corresponding authors

Correspondence to Lulong Bo or Zhichao Jin.

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Ethical approval and consent to participate

The MIMIC-IV and Eicu database were approved by the Massachusetts Institute of Technology (Cambridge, MA) and Beth Israel Deaconess Medical Center (Boston, MA), and consent was obtained for the original data collection.

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Not applicable.

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The authors declare no competing interests.

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Chi Peng, Lijie Chi, Mengjie Chen, and Liwei Peng contributed equally to this work and are co-first authors.

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Peng, C., Chi, L., Chen, M. et al. Effect of continuous hypertonic saline infusion on clinical outcomes in patients with traumatic brain injury. Neurosurg Rev 47, 78 (2024). https://doi.org/10.1007/s10143-024-02316-0

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