Abstract
Background
Hypertonic sodium chloride solutions are routinely used to control raised intracranial pressure (ICP) after traumatic brain injury but have the potential to cause a hyperchloremic metabolic acidosis. Sodium bicarbonate 8.4% has previously been shown to reduce ICP and we have therefore conducted a randomized controlled trial to compare these two solutions.
Methods
Patients with severe traumatic brain injury were randomly allocated to receive an equiosmolar dose of either 100 ml of sodium chloride 5% or 85 ml of sodium bicarbonate 8.4% for each episode of intracranial hypertension. ICP and blood pressure were measured continuously. Arterial pCO2, sodium, chloride, osmolality, and pH were measured at intervals.
Results
We studied 20 episodes of intracranial hypertension in 11 patients. Treatments with 8.4% sodium bicarbonate and 5% sodium chloride reduced raised ICP effectively with a significant fall in ICP from baseline at all time points (P < 0.001). There was no significant difference in ICP with time between those episodes treated with 5% sodium chloride or 8.4% sodium bicarbonate, P = 0.504. Arterial pH was raised after treatment with 8.4% sodium bicarbonate.
Conclusions
An equiosmolar infusion of 8.4% sodium bicarbonate is as effective as 5% sodium chloride for reduction of raised ICP after traumatic brain injury when infused over 30 min.
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Acknowledgments
We are grateful to Paul White from the University of the West of England for his help with the statistical analysis. This study was supported by a small grant from the Frenchay Hospital anaesthetic department research fund.
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Bourdeaux, C.P., Brown, J.M. Randomized Controlled Trial Comparing the Effect of 8.4% Sodium Bicarbonate and 5% Sodium Chloride on Raised Intracranial Pressure after Traumatic Brain Injury. Neurocrit Care 15, 42–45 (2011). https://doi.org/10.1007/s12028-011-9512-0
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DOI: https://doi.org/10.1007/s12028-011-9512-0