Background

In traumatic brain injury (TBI) patients desmopressin administration may induce rapid decreases in serum sodium and increase intracranial pressure (ICP).

Aim

In an international multi-centre study, we aimed to report changes in serum sodium and ICP after desmopressin administration in TBI patients.

Methods

We obtained data from 14 neurotrauma ICUs in Europe, Australia and UK for severe TBI patients (GCS ≤ 8) requiring ICP monitoring. We identified patients who received any desmopressin and recorded daily dose, 6-hourly serum sodium, and 6-hourly ICP.

Results

We studied 262 severe TBI patients. Of these, 39 patients (14.9%) received desmopressin. Median length of treatment with desmopressin was 1 [1–3] day and daily intravenous dose varied between centres from 0.125 to 10 mcg. The median hourly rate of decrease in serum sodium was low (− 0.1 [− 0.2 to 0.0] mmol/L/h) with a median period of decrease of 36 h. The proportion of 6-h periods in which the rate of natremia correction exceeded 0.5 mmol/L/h or 1 mmol/L/h was low, at 8% and 3%, respectively, and ICPs remained stable. After adjusting for IMPACT score and injury severity score, desmopressin administration was independently associated with increased 60-day mortality [HR of 1.83 (1.05–3.24) (p = 0.03)].

Conclusions

In severe TBI, desmopressin administration, potentially representing instances of diabetes insipidus is common and is independently associated with increased mortality. Desmopressin doses vary markedly among ICUs; however, the associated decrease in natremia rarely exceeds recommended rates and median ICP values remain unchanged. These findings support the notion that desmopressin therapy is safe.

中文翻译：

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去氨加压素治疗严重脑外伤患者的血清钠和颅内压变化：一项多中心队列研究。

背景

在颅脑外伤（TBI）患者中，去氨加压素的使用可能会导致血清钠快速下降并增加颅内压（ICP）。

目标

在一项国际多中心研究中，我们旨在报告在TBI患者中使用去氨加压素后血清钠和ICP的变化。

方法

我们从欧洲，澳大利亚和英国的14例神经外伤性ICU中获得了需要ICP监测的严重TBI患者（GCS≤8）的数据。我们确定了接受去氨加压素治疗的患者，并记录了每日剂量，每天6小时的血清钠和6小时的ICP。

结果

我们研究了262名重度TBI患者。其中，有39名患者（14.9％）接受去氨加压素治疗。去氨加压素治疗的中位时间为1 [1-3]天，中心之间的每日静脉注射剂量在0.125到10 mcg之间变化。血清钠每小时的中位数下降率较低（-0.1 [-0.2至0.0] mmol / L / h），中位数下降时间为36小时。血钠校正速率超过0.5 mmol / L / h或1 mmol / L / h的6小时周期所占比例较低，分别为8％和3％，并且ICP保持稳定。在调整了IMPACT评分和损伤严重程度评分后，去氨加压素的给药与60天死亡率的增加独立相关[HR为1.83（1.05-3.24）（p  = 0.03）]。

结论

在严重的TBI中，去氨加压素给药（可能代表尿崩症）很常见，并且与死亡率增加独立相关。去加加压素的剂量在ICU之间明显不同；然而，相关的血钠减少很少超过建议的比率，ICP中位数保持不变。这些发现支持去氨加压素治疗安全的观点。