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Hyperosmolar therapy in pediatric traumatic brain injury: a retrospective study.
Childs Nerv Syst 2016; 32(12):2363-2368CN

Abstract

OBJECTIVES

The objectives of the study are to describe the use of hyperosmolar therapy in pediatric traumatic brain injury (TBI) and examine its effect on intracranial pressure (ICP) and cerebral perfusion pressure (CPP).

DESIGN

A retrospective review of patients with severe TBI admitted to the pediatric intensive care unit (PICU) was conducted. Inclusion criteria were ICP monitoring and administration of a hyperosmolar agent (20 % mannitol or 3 % hypertonic saline) within 48 h of PICU admission; for which dose and timing were recorded. For the first two boluses received for increased ICP (>20 mmHg), the impact on ICP and CPP was assessed during the following 4 h, using repeated measures ANOVA. Co-interventions to control ICP (additional hyperosmolar agent, propofol, or barbiturate bolus) and serum sodium were also documented.

SETTING

A tertiary care pediatric hospital center.

PATIENTS

Children aged 1 month to 18 years, with severe traumatic brain injury (Glasgow Coma Score ≤ 8) and intracranial pressure (ICP) monitor.

RESULTS

Sixty-four patients were eligible, of which 16 met inclusion criteria. Average age was 11 years (SD ± 4) and median Glasgow Coma Score was 6 (range 4-7). Seventy percent of boluses were 3 % hypertonic saline, with no identified baseline difference associated with this initial choice. Both mannitol and hypertonic saline were followed by a non-significant decrease in ICP (mannitol, p = 0.055 and hypertonic saline, p = 0.096). There was no significant change in CPP post bolus. A co-intervention occurred in 69 % of patients within the 4 h post hyperosmolar agent, and eight patients received continuous 3 % saline.

CONCLUSION

In pediatric TBI with intracranial hypertension, mannitol and 3 % hypertonic saline are commonly used, but dose and therapeutic threshold for use vary without clear indications for one versus another. Controlled trials are warranted, but several barriers were identified, including high exclusion rate, multiple co-interventions, and care variability.

Authors+Show Affiliations

Department of Critial Care, CHU Sainte-Justine, University de Montréal, 3175 Cote Sainte-Catherine, Montreal, Québec, H3T 1C5, Canada. nadia.roumeliotis@gmail.com.Research Center of CHU Sainte-Justine, University de Montréal, Montréal, QC, Canada.Department of Critial Care, CHU Sainte-Justine, University de Montréal, 3175 Cote Sainte-Catherine, Montreal, Québec, H3T 1C5, Canada.Department of Neurosurgery, CHU Sainte-Justine, University de Montréal, Montréal, QC, Canada.Department of Critial Care, CHU Sainte-Justine, University de Montréal, 3175 Cote Sainte-Catherine, Montreal, Québec, H3T 1C5, Canada.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

27568371

Citation

Roumeliotis, Nadia, et al. "Hyperosmolar Therapy in Pediatric Traumatic Brain Injury: a Retrospective Study." Child's Nervous System : ChNS : Official Journal of the International Society for Pediatric Neurosurgery, vol. 32, no. 12, 2016, pp. 2363-2368.
Roumeliotis N, Dong C, Pettersen G, et al. Hyperosmolar therapy in pediatric traumatic brain injury: a retrospective study. Childs Nerv Syst. 2016;32(12):2363-2368.
Roumeliotis, N., Dong, C., Pettersen, G., Crevier, L., & Emeriaud, G. (2016). Hyperosmolar therapy in pediatric traumatic brain injury: a retrospective study. Child's Nervous System : ChNS : Official Journal of the International Society for Pediatric Neurosurgery, 32(12), pp. 2363-2368.
Roumeliotis N, et al. Hyperosmolar Therapy in Pediatric Traumatic Brain Injury: a Retrospective Study. Childs Nerv Syst. 2016;32(12):2363-2368. PubMed PMID: 27568371.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Hyperosmolar therapy in pediatric traumatic brain injury: a retrospective study. AU - Roumeliotis,Nadia, AU - Dong,Christian, AU - Pettersen,Géraldine, AU - Crevier,Louis, AU - Emeriaud,Guillaume, Y1 - 2016/08/27/ PY - 2016/04/02/received PY - 2016/08/19/accepted PY - 2016/8/29/pubmed PY - 2017/3/16/medline PY - 2016/8/29/entrez KW - 3 % hypertonic saline KW - Hyperosmolar therapy KW - Intracranial hypertension KW - Mannitol KW - Pediatric KW - Traumatic brain injury SP - 2363 EP - 2368 JF - Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery JO - Childs Nerv Syst VL - 32 IS - 12 N2 - OBJECTIVES: The objectives of the study are to describe the use of hyperosmolar therapy in pediatric traumatic brain injury (TBI) and examine its effect on intracranial pressure (ICP) and cerebral perfusion pressure (CPP). DESIGN: A retrospective review of patients with severe TBI admitted to the pediatric intensive care unit (PICU) was conducted. Inclusion criteria were ICP monitoring and administration of a hyperosmolar agent (20 % mannitol or 3 % hypertonic saline) within 48 h of PICU admission; for which dose and timing were recorded. For the first two boluses received for increased ICP (>20 mmHg), the impact on ICP and CPP was assessed during the following 4 h, using repeated measures ANOVA. Co-interventions to control ICP (additional hyperosmolar agent, propofol, or barbiturate bolus) and serum sodium were also documented. SETTING: A tertiary care pediatric hospital center. PATIENTS: Children aged 1 month to 18 years, with severe traumatic brain injury (Glasgow Coma Score ≤ 8) and intracranial pressure (ICP) monitor. RESULTS: Sixty-four patients were eligible, of which 16 met inclusion criteria. Average age was 11 years (SD ± 4) and median Glasgow Coma Score was 6 (range 4-7). Seventy percent of boluses were 3 % hypertonic saline, with no identified baseline difference associated with this initial choice. Both mannitol and hypertonic saline were followed by a non-significant decrease in ICP (mannitol, p = 0.055 and hypertonic saline, p = 0.096). There was no significant change in CPP post bolus. A co-intervention occurred in 69 % of patients within the 4 h post hyperosmolar agent, and eight patients received continuous 3 % saline. CONCLUSION: In pediatric TBI with intracranial hypertension, mannitol and 3 % hypertonic saline are commonly used, but dose and therapeutic threshold for use vary without clear indications for one versus another. Controlled trials are warranted, but several barriers were identified, including high exclusion rate, multiple co-interventions, and care variability. SN - 1433-0350 UR - https://www.unboundmedicine.com/medline/citation/27568371/Hyperosmolar_therapy_in_pediatric_traumatic_brain_injury:_a_retrospective_study_ L2 - https://dx.doi.org/10.1007/s00381-016-3231-y DB - PRIME DP - Unbound Medicine ER -