Sodium lactate versus mannitol in the treatment of intracranial hypertensive episodes in severe traumatic brain-injured patients.
Level 2 - randomized trial
Individual randomized controlled trial
PubMed 18807008 · doi:10.1007/s00134-008-1283-5
What was done
A prospective, open-label randomized trial was conducted in an adult ICU involving 34 patients with isolated severe traumatic brain injury (Glasgow Coma Scale ≤ 8) and intracranial hypertension. Patients were allocated to receive equiosmolar and isovolumic infusions of either sodium lactate or mannitol. Rescue therapy via crossover to the alternative solution was allowed if intracranial pressure (ICP) could not be controlled. The primary endpoint was efficacy in lowering ICP after 4 hours; secondary endpoints included the percentage of successfully treated intracranial hypertensive episodes and long-term Glasgow Outcome Scale (GOS). Intention-to-treat and actual-treatment analyses were performed.
What was found
Compared to mannitol, sodium lactate resulted in a significantly greater reduction in ICP (7 vs. 4 mmHg, P = 0.016) and a more sustained decrease at the fourth hour (-5.9 ± 1 vs. -3.2 ± 0.9 mmHg, P = 0.009). Hypertensive episodes were more frequently treated successfully with sodium lactate (90.4% vs. 70.4%, P = 0.053). The abstract mentions improved long-term GOS with sodium lactate compared to mannitol, but does not provide numerical values or confidence intervals for GOS.
Why it matters
This study suggests that hyperosmolar sodium lactate can provide greater and more sustained ICP reduction than equiosmolar mannitol during acute intracranial hypertension episodes in severe TBI.
Limits
The study was small (n = 34) and open-label, which introduces potential performance and observer bias. Crossover rescue therapy may complicate long-term outcome interpretation, and specific numeric data for long-term functional outcomes (GOS) were omitted from the abstract.
Cited by
- supports Infusing traumatic brain injury (TBI) patients with sodium lactate improves TBI outcomes as measured by Glasgow scores.