Article (Scientific journals)
Fluid balance and outcome in critically ill patients with traumatic brain injury (CENTER-TBI and OzENTER-TBI): a prospective, multicentre, comparative effectiveness study.
Wiegers, Eveline Janine Anna; Lingsma, Hester Floor; Huijben, Jilske Antonia et al.
2021In The Lancet. Neurology, 20 (8), p. 627-638
Peer reviewed
 

Files


Full Text
article fluid balance and outcome in critically ill patients with traumatic brain injury.pdf
Author postprint (1.49 MB)
Download

All documents in ORBi are protected by a user license.

Send to



Details



Keywords :
Adult; Aged; Brain Injuries, Traumatic/metabolism/mortality; Cohort Studies; Critical Care; Critical Illness; Female; Fluid Therapy/methods; Glasgow Coma Scale; Glasgow Outcome Scale; Humans; Male; Middle Aged; Prospective Studies; Tomography, X-Ray Computed; Treatment Outcome; Water-Electrolyte Balance
Abstract :
[en] BACKGROUND: Fluid therapy-the administration of fluids to maintain adequate organ tissue perfusion and oxygenation-is essential in patients admitted to the intensive care unit (ICU) with traumatic brain injury. We aimed to quantify the variability in fluid management policies in patients with traumatic brain injury and to study the effect of this variability on patients' outcomes. METHODS: We did a prospective, multicentre, comparative effectiveness study of two observational cohorts: CENTER-TBI in Europe and OzENTER-TBI in Australia. Patients from 55 hospitals in 18 countries, aged 16 years or older with traumatic brain injury requiring a head CT, and admitted to the ICU were included in this analysis. We extracted data on demographics, injury, and clinical and treatment characteristics, and calculated the mean daily fluid balance (difference between fluid input and loss) and mean daily fluid input during ICU stay per patient. We analysed the association of fluid balance and input with ICU mortality and functional outcome at 6 months, measured by the Glasgow Outcome Scale Extended (GOSE). Patient-level analyses relied on adjustment for key characteristics per patient, whereas centre-level analyses used the centre as the instrumental variable. FINDINGS: 2125 patients enrolled in CENTER-TBI and OzENTER-TBI between Dec 19, 2014, and Dec 17, 2017, were eligible for inclusion in this analysis. The median age was 50 years (IQR 31 to 66) and 1566 (74%) of patients were male. The median of the mean daily fluid input ranged from 1·48 L (IQR 1·12 to 2·09) to 4·23 L (3·78 to 4·94) across centres. The median of the mean daily fluid balance ranged from -0·85 L (IQR -1·51 to -0·49) to 1·13 L (0·99 to 1·37) across centres. In patient-level analyses, a mean positive daily fluid balance was associated with higher ICU mortality (odds ratio [OR] 1·10 [95% CI 1·07 to 1·12] per 0·1 L increase) and worse functional outcome (1·04 [1·02 to 1·05] per 0·1 L increase); higher mean daily fluid input was also associated with higher ICU mortality (1·05 [1·03 to 1·06] per 0·1 L increase) and worse functional outcome (1·04 [1·03 to 1·04] per 1-point decrease of the GOSE per 0·1 L increase). Centre-level analyses showed similar associations of higher fluid balance with ICU mortality (OR 1·17 [95% CI 1·05 to 1·29]) and worse functional outcome (1·07 [1·02 to 1·13]), but higher fluid input was not associated with ICU mortality (OR 0·95 [0·90 to 1·00]) or worse functional outcome (1·01 [0·98 to 1·03]). INTERPRETATION: In critically ill patients with traumatic brain injury, there is significant variability in fluid management, with more positive fluid balances being associated with worse outcomes. These results, when added to previous evidence, suggest that aiming for neutral fluid balances, indicating a state of normovolaemia, contributes to improved outcome. FUNDING: European Commission 7th Framework program and the Australian Health and Medical Research Council.
Disciplines :
Human health sciences: Multidisciplinary, general & others
Author, co-author :
Wiegers, Eveline Janine Anna;  Department of Public Health, Erasmus MC University Medical Centre Rotterdam,
Lingsma, Hester Floor;  Department of Public Health, Erasmus MC University Medical Centre Rotterdam,
Huijben, Jilske Antonia;  Department of Public Health, Erasmus MC University Medical Centre Rotterdam,
Cooper, David James;  Australian and New Zealand Intensive Care Research Centre, School of Public Health
Citerio, Giuseppe;  School of Medicine and Surgery, University of Milano-Bicocca, Monza, MB, Italy,
Frisvold, Shirin;  Department of Intensive Care Medicine, University Hospital of North Norway, Tromsø,
Helbok, Raimund;  Department of Neurology, Neurocritical Care, Medical University of Innsbruck,
Maas, Andrew Ian Ramsay;  Department of Neurosurgery, Antwerp University Hospital and University of Antwerp,
Menon, David Krishna;  Division of Anaesthesia, University of Cambridge, Addenbrooke's Hospital, Cambridge,
Moore, Elizabeth Madeleine;  Transfusion Research Unit, School of Public Health and Preventive Medicine, Monash
Stocchetti, Nino;  Neuroscience Intensive Care Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore
Dippel, Diederik Willem;  Department of Neurology, Erasmus University Medical Center, Rotterdam, Netherlands.
Steyerberg, Ewout Willem;  Department of Public Health, Erasmus MC University Medical Centre Rotterdam,
van der Jagt, Mathieu;  Department of Intensive Care Adults, Erasmus MC - University Medical Center,
CENTER-TBI
OzENTER-TBI Collaboration, Groups
More authors (6 more) Less
Other collaborator :
Brooker, Joanne
Bragge, Peter
Rosenfeld, Jeffrey
Cooper, Jamie D
Helbok, Raimund
Beer, Ronny
Schoechl, Herbert
Rusnák, Martin
Schwendenwein, Elisabeth
Antoni, Anna
De Keyser, Véronique ;  Université de Liège - ULiège > Département de Psychologie
Menovsky, Tomas
Van Praag, Dominique
Maas, Andrew I R
Van der Steen, Gregory
Parizel, Paul M
Vande Vyvere, Thijs
Depreitere, Bart
Van Hecke, Wim
Verheyden, Jan
Misset, Benoît ;  Centre Hospitalier Universitaire de Liège - CHU > > Service des soins intensifs
LEDOUX, Didier  ;  Centre Hospitalier Universitaire de Liège - CHU > > Service des soins intensifs
LAUREYS, Steven  ;  Centre Hospitalier Universitaire de Liège - CHU > > Centre du Cerveau²
GHUYSEN, Alexandre ;  Centre Hospitalier Universitaire de Liège - CHU > > Service des urgences
Maréchal, Hugues
Dulière, Guy-Loup
Gao, Guoyi
Jiang, Ji-Yao
Kondziella, Daniel
Fabricius, Martin
Schou, Rico Frederik
Blaabjerg, Morten
Rosenlund, Christina
Piippo-Karjalainen, Anna
Raj, Rahul
Pirinen, Matti
Ripatti, Samuli
Palotie, Aarno
Ylén, Peter
Posti, Jussi P
Tenovuo, Olli
Takala, Riikka
Payen, Jean-François
Vega, Emmanuel
Lejeune, Aurelie
Audibert, Gérard
Degos, Vincent
Benali, Habib
Galanaud, Damien
Perlbarg, Vincent
Puybasset, Louis
Azouvi, Philippe
Legrand, Valerie
Dahyot-Fizelier, Claire
Rossaint, Rolf
Coburn, Mark Steven
Kowark, Ana
Clusmann, Hans
Dreier, Jens
Wolf, Stefan
Vajkoczy, Peter
Maegele, Marc
Gratz, Johannes
Schäfer, Nadine
Lefering, Rolf
Covic, Amra
von Steinbüchel, Nicole
Schmidt, Silke
Bullinger, Monika
Younsi, Alexander
Unterberg, Andreas
Mattern, Julia
Sakowitz, Oliver
Sanchez-Porras, Renan
Perera, Natascha
Beauvais, Romuald
Sandor, Janos
Czeiter, Endre
Buki, Andras
Ezer, Erzsébet
Vámos, Zoltán
Melegh, Béla
Tamás, Viktória
Sorinola, Abayomi
Kovács, Noémi
Nyirádi, József
Amrein, Krisztina
Barzó, Pál
Gupta, Deepak
Levi, Leon
Rosenthal, Guy
Furmanov, Alex
Martino, Costanza
Beretta, Luigi
Calvi, Maria Rosa
Azzolini, Maria Luisa
Stocchetti, Nino
Calappi, Emiliana
Zoerle, Tommaso
Ortolano, Fabrizio
Carbonara, Marco
Caccioppola, Alessio
Citerio, Giuseppe
Vargiolu, Alessia
Citerio, Giuseppe
Chieregato, Arturo
Chevallard, Giorgio
Della Corte, Francesco
Grossi, Francesca
Rossi, Sandra
Persona, Paolo
Berardino, Maurizio
Cavallo, Simona
Rambadagalla, Malinka
Ziverte, Agate
Giga, Lelde
Valeinis, Egils
Vilcinis, Rimantas
Tamosuitis, Tomas
Rocka, Saulius
Ragauskas, Arminas
van der Naalt, Joukje
Jacobs, Bram
Steyerberg, Ewout W
Bartels, Ronald
den Boogert, Hugo
Kompanje, Erwin
Timmers, Marjolijn
Foks, Kelly
Haitsma, Iain
Volovici, Victor
van der Jagt, Mathieu
Haagsma, Juanita A
Mikolic, Ana
Lingsma, Hester
Velt, Kimberley
Huijben, Jilske
Voormolen, Daphne
Nieboer, Daan
Wiegers, Eveline
Sewalt, Charlie
Gravesteijn, Benjamin
Polinder, Suzanne
Steyerberg, Ewout W
Tibboel, Dick
van Wijk, Roel
van Dijck, Jeroen T J M
van Essen, Thomas A
Peul, Wilco
Schoonman, Guus
Jones, Kelly
Feigin, Valery L
Te Ao, Braden
Theadom, Alice
Helseth, Eirik
Roe, Cecilie
Roise, Olav
Roise, Olav
Andelic, Nada
Frisvold, Shirin
Andreassen, Lasse
Anke, Audny
Vik, Anne
Skandsen, Toril
Vik, Anne
Skandsen, Toril
Ples, Horia
Tudora, Cristina Maria
Negru, Ancuta
Vulekovic, Peter
Đilvesi, Đula
Karan, Mladen
Golubovic, Jagoš
Rehorcíková, Veronika
Taylor, Mark Steven
Brazinova, Alexandra
Majdan, Marek
Sahuquillo, Juan
Radoi, Andreea
Carbayo Lozano, Guillermo
Pomposo, Inigo
Lagares, Alfonso
Gomez, Pedro A
Castaño-León, Ana M
Gagliardo, Pablo
Oresic, Matej
Bellander, Bo-Michael
Lanyon, Linda
George, Pradeep
Muraleedharan, Visakh
Nelson, David
Ackerlund, Cecilia
Koskinen, Lars-Owe
Sundström, Nina
Brorsson, Camilla
Belli, Antonio
Manara, Alex
Thomas, Matt
Czosnyka, Marek
Smielewski, Peter
Cabeleira, Manuel
Coles, Jonathan
Richardson, Sylvia
Zeiler, Frederick A
Stamatakis, Emmanuel
Williams, Guy
Menon, David
Ercole, Ari
Dixit, Abhishek
Newcombe, Virginia
Richter, Sophie
McFadyen, Charles
Hutchinson, Peter J
Kolias, Angelos G
Adams, Hadie
Correia, Marta
Rhodes, Jonathan
Stewart, William
McMahon, Catherine
Rueckert, Daniel
Glocker, Ben
Tolias, Christos
Dawes, Helen
Esser, Patrick
van Heugten, Caroline
Curry, Nicola
Stanworth, Simon
Lecky, Fiona
Lecky, Fiona
Otesile, Olubukola
Johnson, Faye
Dark, Paul
Jankowski, Stefan
Lightfoot, Roger
Wilson, Lindsay
Horton, Lindsay
Stevens, Robert
Palotie, Aarno
Rosand, Jonathan
Manley, Geoffrey
Jarrett, Mike
Brinck, Vibeke
Wang, Kevin K W
Yang, Zhihui
Vespa, Paul M
Gruen, Russell L
Cameron, Peter
Donoghue, Emma
Cooper, Jamie D
Gantner, Dashiell
Gruen, Russel
Murray, Lynette
Rosenfeld, Jeffrey V
Varma, Dinesh
Trapani, Tony
Vallance, Shirley
MacIsaac, Cristopher
Jordan, Andrea
More authors (248 more) Less
Language :
English
Title :
Fluid balance and outcome in critically ill patients with traumatic brain injury (CENTER-TBI and OzENTER-TBI): a prospective, multicentre, comparative effectiveness study.
Publication date :
August 2021
Journal title :
The Lancet. Neurology
eISSN :
1474-4465
Volume :
20
Issue :
8
Pages :
627-638
Peer reviewed :
Peer reviewed
Commentary :
Copyright © 2021 Elsevier Ltd. All rights reserved.
Available on ORBi :
since 27 March 2022

Statistics


Number of views
531 (2 by ULiège)
Number of downloads
705 (1 by ULiège)

Scopus citations®
 
34
Scopus citations®
without self-citations
26
OpenCitations
 
11

Bibliography


Similar publications



Contact ORBi