The safety of synthetic colloid in critically ill patients with severe traumatic brain injuries

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• 作者：Mypinder S.  ; Sekhon MD^a ; Vinay  ; Dhingra K. MD ; FRCPC^b ; Indeep S.  ; Sekhon BSc^a ; William R.  ; Henderson MD ; FRCPC^b ; Neilson  ; McLean MD ; FRCPC^b ; Donald E.G.  ; Griesdale MD ; MPH ; FRCPC^b ;   ; ^c ;   ; ^d ;   ; ^{dgriesdale@post.harvard.edu}
• 关键词：Colloid ; Traumatic brain injury ; Crystalloid
• 刊名：Journal of Critical Care
• 出版年：2011
• 出版时间：August 2011
• 年：2011
• 卷：26
• 期：4
• 页码：357-362
• 全文大小：233 K

文摘

Purpose

Although 4 % albumin is associated with increased mortality in patients with traumatic brain injury (TBI), evidence concerning the safety of synthetic colloids is lacking. We aimed to determine if there is an association between synthetic colloids and mortality in patients with severe TBI.

Materials and Methods

A retrospective cohort study of patients with severe TBI was conducted. Data were collected on all intravenous fluids administered during the first 14 days of admission. Multivariable Cox proportional hazards regression was used to model the association between daily cumulative pentastarch quintiles and mortality.

Results

Patients receiving pentastarch had higher Acute Physiology and Chronic Health II scores (23.9 vs 21.6, P < .01), frequency of craniotomy (42.5 % vs 21.6 % , P = .02), longer duration of intensive care unit stay (12 vs 4 days, P < .01), and mechanical ventilation (10 vs 3 days, P < .01). On unadjusted Cox regression, patients in the highest quintile of cumulative pentastarch administration had a higher rate of mortality compared with those receiving no colloid (hazard ratio, 3.8; 95 % confidence interval, 1.2-12.4; P = .03). However, this relationship did not persist in the final multivariable model (hazard ratio 1.0; 95 % confidence interval, 0.25-4.1; P = .98).

Conclusion

There was no association between cumulative exposure to pentastarch and mortality in patients with severe TBI.