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Effect of Continuous Infusion of Hypertonic Saline vs Standard Care on 6-Month Neurological Outcomes in Patients with Traumatic Brain Injury

By Currents Editor posted 07-09-2021 09:50


Journal of the American Medical Association (05/25/21)  DOI: 10.1001/jama.2021.5561

Roquilly, Antoine; Moyer, Jean Denis; Huet, Olivier; et al. 

For the COBI clinical trial, researchers compared outcomes in adults with traumatic brain injury (TBI) after treatment with or without continuous infusion of hypertonic saline solution. Fluid therapy is critical for individuals sustaining this type of damage, but its effect on neurological recovery was unknown. To learn more, investigators enrolled 370 ICU patients suffering from severe TBI, all of whom received standard care. Half of the participants were randomized to also receive continuous infusion of 20% hypertonic saline solution for at least 48 hours. At 6 months, investigators assessed whether neurological status was notably better with the combined treatment. While they did calculate an odds ratio of 1.02 for better neurological outcomes in the intervention group based on Extended Glasgow Outcome Scale scores, the difference did not bear statistical significance. Additionally, of 12 secondary outcomes—including death within 6 months and development of intracranial hypertension—10 were not significantly different between groups. The findings suggest that giving patients with TBI continuous infusion with hypertonic saline is no better than standard care in terms of neurological status at 6-month followup. However, the study authors note that the research may have been underpowered to detect a clinically meaningful difference.


Lauren Koffman, DO, MS As a member of the Educational Products Committee, one of many committees within the Neurocritical Care Society, I was recently asked to review A Guide to Traumatic Brain Injury: The Intensive Care Unit . This guide was written several years ago by Dr. David Y. Hwang and ...
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