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

Ichai, Carole; Armando, Guy; Orban, Jean-Christophe; Berthier, Frederic; Rami, Laurent; Samat-Long, Corine; Grimaud, Dominique; Leverve, Xavier
March 2009
Intensive Care Medicine;Mar2009, Vol. 35 Issue 3, p471
Academic Journal
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). Prospective open randomized study in an adult ICU. 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. 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). 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.


Related Articles

  • Bifrontal Biparietal Cruciate Decompressive Craniectomy in Pediatric Traumatic Brain Injury. McHugh, Daryl C.; Fiore, Susan M.; Strong, Nancy; Egnor, Michael R. // Pediatric Neurosurgery;Jan2019, Vol. 54 Issue 1, p6 

    Background: We investigated a novel surgical approach to decompressive craniectomy (DC), the bifrontal biparietal, or "cruciate," craniectomy, in severe pediatric traumatic brain injury (TBI). Cruciate DC was designed with a fundamentally different approach to intracranial pressure (ICP) control...

  • Therapeutic Hypothermia in Brain Trauma Injury: Controversies. Alvis-Miranda, Hernando Raphael; Alcala-Cerra, Gabriel; Rubiano, Andres M.; Ramirez, Omar; Moscote-Salazar, Luis Rafael // Romanian Neurosurgery;2014, Vol. 21 Issue 3, p259 

    Traumatic brain injury (TBI) is a common cause of death and disability in developed countries. It is a major cause of mortality in young patients worldwide. Intracranial hypertension is the cause of death in more than 80% of patients with TBI. When secondary lesions occur, start a number of...

  • Delayed Intracranial Hypertension and Cerebral Edema in Severe Pediatric Head Injury: Risk Factor Analysis. Bennett Colomer, Carlos; Solari Vergara, Felipe; Tapia Perez, Felipe; Miranda Vasquez, Francisca; Horlacher Kunstmann, Andres; Parra Fierro, Gilda; Salazar Zenkovich, Cristián // Pediatric Neurosurgery;Jun2013, Vol. 48 Issue 4, p205 

    Introduction: Diffuse brain edema has been described as a major cause of intracranial hypertension (IH) following traumatic brain injury (TBI), and several studies suggest that it may be more frequent in children than in adults. While most cases of IH following TBI are present from the...

  • REANIMAREA NOU-NÄ‚SCUTULUI ÅžI SUGARULUI. Popescu, Valeriu; Zamfirescu, Andrei // Romanian Journal of Pediatrics;2009, Vol. 58 Issue 3, p260 

    The authors present: 1. What patients ought to be transferred in an intensive care unit 2. Parenteral feeding 3. Daily needs (per weight and in 24 hours) 4. Treatment of cerebral edema 5. General principles of hypothermia treatment 6. Prescribing dangerous drugs in an infant 7. Diet of an infant...

  • Incidence, treatment, and outcome of severe sepsis in ICU-treated adults in Finland: the Finnsepsis study. Karlsson, Sari; Varpula, Marjut; Ruokonen, Esko; Pettilä, Ville; Parviainen, Ilkka; Ala-Kokko, Tero; Kolho, Elina; Rintala, Esa; Pettilä, Ville; Ala-Kokko, Tero I; Rintala, Esa M // Intensive Care Medicine;Mar2007, Vol. 33 Issue 3, p435 

    Objective: To determine the incidence and outcome of severe sepsis in the adult Finnish population and to evaluate how treatment guidelines in severe sepsis are applied in clinical practice.Study Design: A prospective study in 24 closed multidisciplinary ICUs in 21...

  • Fatal cerebral malaria: a venous efflux problem. Frevert, Ute; Nacer, Adéla // Frontiers in Cellular & Infection Microbiology;Nov2014, p1 

    Most Plasmodium falciparum-infected children with cerebral malaria (CM) die from respiratory arrest, but the underlying pathology is unclear. Here we present a model in which the ultimate cause of death from CM is severe intracranial hypertension. Dynamic imaging of mice infected with P. berghei...

  • Mechanism and Therapy of Brain Edema after Intracerebral Hemorrhage. Zheng, Haiping; Chen, Chunli; Zhang, Jie; Hu, Zhiping // Cerebrovascular Diseases;Jul2016, Vol. 42 Issue 3/4, p155 

    Background: Intracerebral hemorrhage (ICH) is a subtype of stroke with a severe high mortality and disability rate and accounts for about 10-15% of all strokes. The oppression and destruction by hematoma to brain tissue cause the primary brain injury. The inflammation and coagulation response...

  • Edema cerebral I: fisiopatología, manifestaciones clínicas, diagnóstico y monitoreo neurológico. Esqueda-Liquidano, Mauricio Armando; Gutiérrez-Cabrera, José de Jesús; Cuéllar-Martínez, Salvador; Vargas-Tentori, Noé; Ariñez-Barahona, Erick; Flores-Álvarez, Eduardo; Ruiz-Pérez, Javier; Esqueda-Liquidano, Lilia; Loo-Salomé, Silvia // Medicina Interna de Mexico;sep/oct2014, Vol. 30 Issue 5, p584 

    Brain edema is a disease frequently found in our clinical practice and in critically ill patients with acute brain damage resulting in increased morbidity and mortality. It is defined, in a comprehensive manner, as the pathological increase in the amount of water in the brain that results in an...

  • Diplopia Due to Systemic Lupus Erythematosus in a Child: A Rare Clinical Presenting Sign of the Disease. Georgakopoulos, Constantine D.; Kargiotis, Odysseas; Eliopoulou, Maria I.; Makri, Olga E.; Exarchou, Artemis M.; Papathanasopoulos, Panagiotis // Journal of Child Neurology;Dec2011, Vol. 26 Issue 12, p1576 

    We present the case of a 14-year-old girl who was admitted to the hospital with the complaint of horizontal diplopia for 48 hours. Initially, she was diagnosed with idiopathic intracranial hypertension. During hospitalization she developed fever, macular facial rash, and chest pain, and because...


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics