Serum sodium and intracranial pressure changes after desmopressin therapy in severe traumatic brain injury patients: a multi-centre cohort study.
- Harrois A Intensive Care Unit, Royal Melbourne Hospital, Parkville, VIC, Australia. harroisanatole@yahoo.fr.
- Anstey JR Intensive Care Unit, Royal Melbourne Hospital, Parkville, VIC, Australia.
- Taccone FS Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium.
- Udy AA Intensive Care Unit, The Alfred Hospital, Melbourne, VIC, Australia.
- Citerio G School of Medicine and Surgery, University Milano Bicocca-Neurointensive Care, San Gerardo Hospital, ASST-Monza, Monza, Italy.
- Duranteau J Department of Anesthesia and Surgical Intensive Care, CHU de Bicetre, APHP, Université Paris Sud, 78 Rue du Général Leclerc, 94270, Le Kremlin Bicêtre, France.
- Ichai C Université Côte d'Azur, Centre hospitalier Universitaire de Nice, Service de Réanimation Polyvalente, Hôpital Pasteur 2, Nice, France.
- Badenes R Department of Anesthesiology and Surgical-Trauma Intensive Care, Hospital Clinic Universitari de Valencia, University of Valencia, Valencia, Spain.
- Prowle JR Adult Critical Care Unit, The Royal London Hospital, Barts Health NHS Trust, London, UK.
- Ercole A Neurosciences and Trauma Critical Care Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
- Oddo M Department of Medical-Surgical Intensive Care Medicine, Faculty of Biology and Medicine, Centre Hospitalier Universitaire, Vaudois (CHUV), University of Lausanne, Lausanne, Switzerland.
- Schneider A Department of Medical-Surgical Intensive Care Medicine, Faculty of Biology and Medicine, Centre Hospitalier Universitaire, Vaudois (CHUV), University of Lausanne, Lausanne, Switzerland.
- van der Jagt M Department of Intensive Care, Erasmus MC-University Medical Center, Rotterdam, The Netherlands.
- Wolf S Department of Neurosurgery, Charité Universitätsmedizin Berlin, Berlin, Germany.
- Helbok R Neurological Intensive Care Unit, Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria.
- Nelson DW Section for Perioperative Medicine and Intensive Care, Department of Physiology and Pharmacology, Karolinska Institute, Stockholm, Sweden.
- Skrifvars MB Division of Intensive Care, Department of Emergency Care and Services, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
- Cooper DJ Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium.
- Bellomo R Intensive Care Unit, Royal Melbourne Hospital, Parkville, VIC, Australia.
- 2019-09-06
Published in:
- Annals of intensive care. - 2019
English
BACKGROUND
In traumatic brain injury (TBI) patients desmopressin administration may induce rapid decreases in serum sodium and increase intracranial pressure (ICP).
AIM
In an international multi-centre study, we aimed to report changes in serum sodium and ICP after desmopressin administration in TBI patients.
METHODS
We obtained data from 14 neurotrauma ICUs in Europe, Australia and UK for severe TBI patients (GCS ≤ 8) requiring ICP monitoring. We identified patients who received any desmopressin and recorded daily dose, 6-hourly serum sodium, and 6-hourly ICP.
RESULTS
We studied 262 severe TBI patients. Of these, 39 patients (14.9%) received desmopressin. Median length of treatment with desmopressin was 1 [1-3] day and daily intravenous dose varied between centres from 0.125 to 10 mcg. The median hourly rate of decrease in serum sodium was low (- 0.1 [- 0.2 to 0.0] mmol/L/h) with a median period of decrease of 36 h. The proportion of 6-h periods in which the rate of natremia correction exceeded 0.5 mmol/L/h or 1 mmol/L/h was low, at 8% and 3%, respectively, and ICPs remained stable. After adjusting for IMPACT score and injury severity score, desmopressin administration was independently associated with increased 60-day mortality [HR of 1.83 (1.05-3.24) (p = 0.03)].
CONCLUSIONS
In severe TBI, desmopressin administration, potentially representing instances of diabetes insipidus is common and is independently associated with increased mortality. Desmopressin doses vary markedly among ICUs; however, the associated decrease in natremia rarely exceeds recommended rates and median ICP values remain unchanged. These findings support the notion that desmopressin therapy is safe.
In traumatic brain injury (TBI) patients desmopressin administration may induce rapid decreases in serum sodium and increase intracranial pressure (ICP).
AIM
In an international multi-centre study, we aimed to report changes in serum sodium and ICP after desmopressin administration in TBI patients.
METHODS
We obtained data from 14 neurotrauma ICUs in Europe, Australia and UK for severe TBI patients (GCS ≤ 8) requiring ICP monitoring. We identified patients who received any desmopressin and recorded daily dose, 6-hourly serum sodium, and 6-hourly ICP.
RESULTS
We studied 262 severe TBI patients. Of these, 39 patients (14.9%) received desmopressin. Median length of treatment with desmopressin was 1 [1-3] day and daily intravenous dose varied between centres from 0.125 to 10 mcg. The median hourly rate of decrease in serum sodium was low (- 0.1 [- 0.2 to 0.0] mmol/L/h) with a median period of decrease of 36 h. The proportion of 6-h periods in which the rate of natremia correction exceeded 0.5 mmol/L/h or 1 mmol/L/h was low, at 8% and 3%, respectively, and ICPs remained stable. After adjusting for IMPACT score and injury severity score, desmopressin administration was independently associated with increased 60-day mortality [HR of 1.83 (1.05-3.24) (p = 0.03)].
CONCLUSIONS
In severe TBI, desmopressin administration, potentially representing instances of diabetes insipidus is common and is independently associated with increased mortality. Desmopressin doses vary markedly among ICUs; however, the associated decrease in natremia rarely exceeds recommended rates and median ICP values remain unchanged. These findings support the notion that desmopressin therapy is safe.
- Language
-
- English
- Open access status
- gold
- Identifiers
-
- DOI 10.1186/s13613-019-0574-z
- PMID 31486921
- Persistent URL
- https://susi.usi.ch/global/documents/13080
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