Intensive Care Medicine

, Volume 35, Issue 3, pp 471–479

Sodium lactate versus mannitol in the treatment of intracranial hypertensive episodes in severe traumatic brain-injured patients

  • Carole Ichai
  • Guy Armando
  • Jean-Christophe Orban
  • Frederic Berthier
  • Laurent Rami
  • Corine Samat-Long
  • Dominique Grimaud
  • Xavier Leverve
Original

Abstract

Objectives

Traumatic brain injury (TBI) is still a major cause of mortality and morbidity. Recent trials have failed to demonstrate a beneficial outcome from therapeutic treatments such as corticosteroids, hypothermia and hypertonic saline. We investigated the effect of a new hyperosmolar solution based on sodium lactate in controlling raised intracranial pressure (ICP).

Design and setting

Prospective open randomized study in an adult ICU.

Patients

Thirty-four patients with isolated severe TBI (Glasgow Coma Scale ≤ 8) and intracranial hypertension were allocated to receive equally hyperosmolar and isovolumic therapy, consisting of either mannitol or sodium lactate. Rescue therapy by crossover to the alternative treatment was indicated when ICP could not be controlled. The primary endpoint was efficacy in lowering ICP after 4 h, with a secondary endpoint of the percentage of successfully treated episodes of intracranial hypertension. The analysis was performed with both intention-to-treat and actual treatments provided.

Measurements and results

Compared to mannitol, the effect of the lactate solution on ICP was significantly more pronounced (7 vs. 4 mmHg, P = 0.016), more prolonged (fourth-hour-ICP decrease: −5.9 ± 1 vs. −3.2 ± 0.9 mmHg, P = 0.009) and more frequently successful (90.4 vs. 70.4%, P = 0.053).

Conclusion

Acute infusion of a sodium lactate-based hyperosmolar solution is effective in treating intracranial hypertension following traumatic brain injury. This effect is significantly more pronounced than that of an equivalent osmotic load of mannitol. Additionally, in this specific group of patients, long-term outcome was better in terms of GOS in those receiving as compared to mannitol. Larger trials are warranted to confirm our findings.

Keywords

TBI Osmotherapy Cerebral edema Plasma ions Neurological outcome Disability 

Supplementary material

134_2008_1283_MOESM1_ESM.doc (137 kb)
ESM1 (DOC 137 kb)
134_2008_1283_MOESM2_ESM.doc (42 kb)
ESM2 (DOC 41.5 kb)

Copyright information

© Springer-Verlag 2008

Authors and Affiliations

  • Carole Ichai
    • 1
  • Guy Armando
    • 1
  • Jean-Christophe Orban
    • 1
  • Frederic Berthier
    • 2
  • Laurent Rami
    • 1
  • Corine Samat-Long
    • 1
  • Dominique Grimaud
    • 1
  • Xavier Leverve
    • 3
  1. 1.Service de Réanimation, Faculté de Médecine and CHU de NiceHôpital Saint-RochNice Cedex 1France
  2. 2.Département d’Informatique MédicaleCHU de Nice, Hôpital CimiezNiceFrance
  3. 3.Inserm U884 and Université Joseph FourierGrenoble CedexFrance

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