Should we ban the use of colloids in patients with head injury?
| العنوان: | Should we ban the use of colloids in patients with head injury? |
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| المؤلفون: | Gérard Audibert, Jean François Payen, Nicolas Bruder, Bernard Vigué |
| المصدر: | Intensive Care Medicine. 38:1561-1562 |
| بيانات النشر: | Springer Science and Business Media LLC, 2012. |
| سنة النشر: | 2012 |
| مصطلحات موضوعية: | Pentastarch, medicine.medical_specialty, education.field_of_study, Evidence-Based Medicine, business.industry, Traumatic brain injury, Critical Illness, Population, Head injury, Brain damage, Critical Care and Intensive Care Medicine, medicine.disease, Surgery, Anesthesia, Post-hoc analysis, Fluid Therapy, Humans, Medicine, Colloids, medicine.symptom, business, education, Hetastarch, Cohort study |
| الوصف: | Dear Editor, We read the recommendations from the ESICM task force on colloid volume therapy in critically ill patients [1]. We express our major concerns over the strong recommendation (grade 1C) not to use synthetic colloids in patients with head injury or intracranial bleeding. Indeed, this statement was based on three clinical studies only [1]. The first was retrospective, and found an association between the risk of death and the use of 6 % hetastarch 450/0.7, a highmolecular-weight hetastarch not used in Europe, in a subgroup of trauma patients with moderate or severe traumatic brain injury. The second study was a post hoc analysis of two randomised controlled trials in patients with aneurismal subarachnoid haemorrhage, and found colloids, i.e., 4 % succinylated gelatin and 6 % pentastarch, as one factor associated with unfavourable neurological outcome at 6 months. The third study was a randomised controlled study in 31 patients with severe traumatic brain injury, and reported no difference in the rate of complications between hydroxyethyl starch solution (HES) 200/0.5 and 6 % HES 130/0.4. In this latter study, 6 % HES 130/0.4 was administered over several days at doses of up to 70 ml/kg/24 h. Based on such limited and heterogeneous data, it appears highly speculative to draw conclusions about the risk of colloids in this population, and we urge that readers consider that an association between variables does not necessarily indicate a causal relation. In addition, two randomised controlled studies must be cited. The first study compared the continuous administration of 6 % HES versus crystalloid solutions over 4 days in 40 patients with acute ischaemic stroke, and found no differences in efficacy or safety between the two groups [2]. Similar findings were reported in a second study comparing 10 % HES 130/0.4 versus crystalloids in 106 patients with acute ischaemic stroke [3]. Further prospective randomised controlled trials are clearly needed to address the issue of how best to optimise fluid resuscitation in this population. This would mitigate the effects of unrecorded confounding factors that may exist in cohort studies even after statistical adjustment. In general, it is difficult to isolate the effects of fluids on neurological outcome independently of their effects on the cardiovascular system. The reasons for myocardial dysfunction are numerous after brain injury, and include pulmonary vasoconstriction centrally mediated by brain damage, associated extra-cranial lesions, and/or large doses of sedatives as part of the treatment of intracranial hypertension. In addition, stress-induced cardiomyopathy does exist in these patients [4]. In this context, fluid overloading may result in severe cardiopulmonary complications regardless of the type of fluid administered. An early goal-directed haemodynamic management to optimise cardiac output and volume status in post-subarachnoid haemorrhage vasospasm was associated with better clinical course and fewer cardiopulmonary complications compared to conventional treatment [5]. In conclusion, it would be more appropriate to recommend the routine monitoring of cardiac function in brain-injured patients rather than recommending any ban on the use of colloids after brain injury. |
| تدمد: | 1432-1238 0342-4642 |
| URL الوصول: | https://explore.openaire.eu/search/publication?articleId=doi_dedup___::ce2ab710ebdeaece04820f989925fbf9 https://doi.org/10.1007/s00134-012-2640-y |
| حقوق: | CLOSED |
| رقم الأكسشن: | edsair.doi.dedup.....ce2ab710ebdeaece04820f989925fbf9 |
| قاعدة البيانات: | OpenAIRE |
Find this article in full text from Springer Verlag. | تدمد: | 14321238 03424642 |
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