Half-molar sodium lactate infusion to prevent intracranial hypertensive episodes in severe traumatic brain injured patients: a randomized controlled trial.
Level 2 - randomized trial
Individual randomized controlled trial
PubMed 23749153 · doi:10.1007/s00134-013-2978-9
What was done
In a double-blind randomized controlled trial, 60 patients with severe traumatic brain injury (TBI) requiring intracranial pressure (ICP) monitoring were randomly assigned to receive a continuous 48-hour infusion (0.5 ml/kg/h) of either half-molar sodium lactate (SL) or isotonic saline initiated within 12 hours post-trauma. The primary outcome was the number of elevated ICP episodes (≥20 mmHg) requiring specific treatment, alongside 48-hour fluid, sodium, and chloride balance measurements.
What was found
Patients receiving half-molar sodium lactate experienced fewer episodes of raised ICP compared to the saline control group (23 vs. 53 episodes, p < 0.05). A smaller proportion of patients developed raised ICP episodes in the SL group than in the control group (11 [36%] vs. 20 patients [66%], p < 0.05). Cumulative 48-hour fluid and chloride balances were also significantly lower in the SL group (both p < 0.01).
Why it matters
Preventive strategies for post-traumatic intracranial hypertension are limited. These findings suggest that early infusion of half-molar sodium lactate can reduce intracranial hypertensive burden and hyperchloremic fluid load compared to standard isotonic saline.
Limits
The study had a small sample size (n = 60) and evaluated outcomes only over the initial 48-hour period. Long-term neurological recovery, functional outcomes, and mortality were not reported in the abstract.
Cited by
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