Balanced versus chloride-rich solutions for fluid resuscitation in brain-injured patients: a randomised double-blind pilot study
Open Access
- 1 January 2013
- journal article
- research article
- Published by Springer Science and Business Media LLC in Critical Care
- Vol. 17 (2), R77
- https://doi.org/10.1186/cc12686
Abstract
We sought to investigate whether the use of balanced solutions reduces the incidence of hyperchloraemic acidosis without increasing the risk for intracranial hypertension in patients with severe brain injury. We conducted a single-centre, two-arm, randomised, double-blind, pilot controlled trial in Nantes, France. Patients with severe traumatic brain injury (Glasgow Coma Scale score ≤8) or subarachnoid haemorrhage (World Federation of Neurosurgical Society grade III or higher) who were mechanically ventilated were randomised within the first 12 hours after brain injury to receive either isotonic balanced solutions (crystalloid and hydroxyethyl starch; balanced group) or isotonic sodium chloride solutions (crystalloid and hydroxyethyl starch; saline group) for 48 hours. The primary endpoint was the occurrence of hyperchloraemic metabolic acidosis within 48 hours. Forty-two patients were included, of whom one patient in each group was excluded (one consent withdrawn and one use of forbidden therapy). Nineteen patients (95%) in the saline group and thirteen (65%) in the balanced group presented with hyperchloraemic acidosis within the first 48 hours (hazard ratio = 0.28, 95% confidence interval [CI] = 0.11 to 0.70; P = 0.006). In the saline group, pH (P = .004) and strong ion deficit (P = 0.047) were lower and chloraemia was higher (P = 0.002) than in the balanced group. Intracranial pressure was not different between the study groups (mean difference 4 mmHg [-1;8]; P = 0.088). Seven patients (35%) in the saline group and eight (40%) in the balanced group developed intracranial hypertension (P = 0.744). Three patients (14%) in the saline group and five (25%) in the balanced group died (P = 0.387). This study provides evidence that balanced solutions reduce the incidence of hyperchloraemic acidosis in brain-injured patients compared to saline solutions. Even if the study was not powered sufficiently for this endpoint, intracranial pressure did not appear different between groups. EudraCT 2008-004153-15 and NCT00847977 The work in this trial was performed at Nantes University Hospital in Nantes, France.Keywords
This publication has 38 references indexed in Scilit:
- Coagulation effects of in vitro serial haemodilution with a balanced electrolyte hetastarch solution compared with a saline‐based hetastarch solution and lactated Ringer's solution*Anaesthesia, 2002
- A prospective, randomized comparison of thromboelastographic coagulation profile in patients receiving lactated Ringer's solution, 6% hetastarch in a balanced-saline vehicle, or 6% hetastarch in saline during major surgeryJournal of Cardiothoracic and Vascular Anesthesia, 2002
- Rapid Saline Infusion Produces Hyperchloremic Acidosis in Patients Undergoing Gynecologic SurgeryAnesthesiology, 1999
- Hextend[registered sign], a Physiologically Balanced Plasma Expander for Large Volume Use in Major SurgeryAnesthesia & Analgesia, 1999
- A prospective, randomized, and controlled study of fluid management in children with severe head injuryCritical Care Medicine, 1998
- Hypertonic Saline Resuscitation of Patients with Head InjuryThe Journal of Trauma and Acute Care Surgery, 1998
- A comparison of Plasmalyte 148 and 0.9% saline for intra‐operative fluid replacementAnaesthesia, 1994
- THE ROLE OF SECONDARY BRAIN INJURY IN DETERMINING OUTCOME FROM SEVERE HEAD INJURYThe Journal of Trauma and Acute Care Surgery, 1993
- Modern quantitative acid–base chemistryCanadian Journal of Physiology and Pharmacology, 1983
- Regulation of Renal Blood Flow by Plasma ChlorideJCI Insight, 1983