Albumin resuscitation for traumatic brain injury: is intracranial hypertension
the cause of increased mortality?
Author(s): Cooper DJ(1), Myburgh J, Heritier S, Finfer S, Bellomo R, Billot L, Murray L,
Vallance S; SAFE-TBI Investigators; Australian and New Zealand Intensive Care
Society Clinical Trials Group.
Affiliation(s): Author information:
(1)Department of Intensive Care, Alfred Hospital, Melbourne, Australia .
Publication date & source: 2013, J Neurotrauma. , 30(7):512-8
Mortality is higher in patients with traumatic brain injury (TBI) resuscitated
with albumin compared with saline, but the mechanism for increased mortality is
unknown. In patients from the Saline vs. Albumin Fluid Evaluation (SAFE) study
with TBI who underwent intracranial pressure (ICP) monitoring, interventional
data were collected from randomization to day 14 to determine changes in ICP
(primary outcome) and in therapies used to treat increased ICP. Pattern mixture
modelling, designed to address informative dropouts, was used to compare temporal
changes between the albumin and saline groups, and 321 patients were identified,
of whom 164 (51.1%) received albumin and 157 (48.9%) received saline. There was a
significant linear increase in mean ICP and significantly more deaths in the
albumin group compared with saline when ICP monitoring was discontinued during
the first week (1.30±0.33 vs. -0.37±0.36, p=0.0006; and 34.4% vs. 17.4%; p=0.006
respectively), but not when monitoring ceased during the second week (-0.08±0.44
vs. -0.23±0.38, p=0.79; and 18.6% vs. 12.1%; p=0.36 respectively). There were
statistically significant differences in the mean total daily doses of morphine
(-0.42±0.07 vs. -0.66±0.0, p=0.0009), propofol (-0.45±0.11 vs. -0.76±0.11;
p=0.034) and norepinephrine (-0.50±0.07 vs. -0.74±0.07) and in temperature
(0.03±0.03 vs. 0.16±0.03; p=0.0014) between the albumin and saline groups when
ICP monitoring ceased during the first week. The use of albumin for resuscitation
in patients with severe TBI is associated with increased ICP during the first
week. This is the most likely mechanism of increased mortality in these patients.
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