The safety of synthetic colloid in critically ill patients with severe traumatic brain injuries |
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Authors: | Sekhon Mypinder S Dhingra Vinay K Sekhon Indeep S Henderson William R McLean Neilson Griesdale Donald E G |
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Affiliation: | aDepartment of Medicine, University of British Columbia, Vancouver, Canada;bDivision of Critical Care Medicine, Department of Medicine, University of British Columbia, and the Program of Critical Care Medicine, Vancouver General Hospital, Vancouver, Canada;cDepartment of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia and the Department of Anesthesia, Vancouver General Hospital, Vancouver, Canada;dCentre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, Vancouver, Canada |
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Abstract: | PurposeAlthough 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 MethodsA 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.ResultsPatients 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).ConclusionThere was no association between cumulative exposure to pentastarch and mortality in patients with severe TBI. |
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Keywords: | Colloid Traumatic brain injury Crystalloid |
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