Jean-Louis Vincent, Ricard Ferrer, Fabio S Taccone, Christian J Wiedermann, Peter Reinstrup
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引用次数: 0
摘要
创伤性脑损伤（TBI）每年影响约6900万人，大多数病例的严重程度为轻度至中度。然而，在严重的TBI中，早期处理至关重要，包括液体复苏以控制颅内压（ICP）和优化脑灌注压。SAFE-TBI研究将低渗4%白蛋白与生理盐水相比与更高的死亡率联系起来(33.2% vs 20.4%；RR 1.63;P = 0.003)，可能是由于颅内压升高，提示指南倾向于生理盐水。然而，这些建议是基于低质量的证据，忽视了高致癌性白蛋白。临床前数据证实低压而非白蛋白驱动ICP升高。新出现的数据表明，高溶性白蛋白（20-25%）可能降低ICP并改善预后。这封信强调了证据差距，并主张重新评估白蛋白在TBI中的使用，特别是高致病性制剂。
Re-evaluating albumin use in traumatic brain injury.
Traumatic brain injury (TBI) affects approximately 69 million people annually, with the majority of cases being mild-to-moderate in severity. However, in severe TBI, early management is critical and includes fluid resuscitation to control intracranial pressure (ICP) and optimize cerebral perfusion pressure. The SAFE-TBI study linked hypotonic 4% albumin to higher mortality versus saline (33.2% vs. 20.4%; RR 1.63; P = 0.003), likely due to elevated ICP, prompting guidelines favoring saline. However, these recommendations are based on low-quality evidence and overlook hyperoncotic albumin. Preclinical data confirm that hypotonicity-not albumin-drives ICP elevation. Emerging data suggest that hyperoncotic albumin (20-25%) may reduce ICP and improve outcomes. This letter highlights evidence gaps and advocates re-evaluating albumin use in TBI, especially hyperoncotic formulations.
期刊介绍：
"Journal of Intensive Care" is an open access journal dedicated to the comprehensive coverage of intensive care medicine, providing a platform for the latest research and clinical insights in this critical field. The journal covers a wide range of topics, including intensive and critical care, trauma and surgical intensive care, pediatric intensive care, acute and emergency medicine, perioperative medicine, resuscitation, infection control, and organ dysfunction.
Recognizing the importance of cultural diversity in healthcare practices, "Journal of Intensive Care" also encourages submissions that explore and discuss the cultural aspects of intensive care, aiming to promote a more inclusive and culturally sensitive approach to patient care. By fostering a global exchange of knowledge and expertise, the journal contributes to the continuous improvement of intensive care practices worldwide.
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