The following is a summary of “Isotonic balanced fluid versus 0.9% saline in patients with moderate to severe traumatic brain injury: A double-blinded randomised controlled trial,” published in the March 2024 issue of Emergency Medicine by Poh, et al.

Traumatic brain injury (TBI) represents a significant global health concern with substantial economic implications. Effective fluid therapy is crucial in TBI management to restore intravascular volume, maintain cerebral perfusion pressure, and prevent secondary brain injury. While 0.9% saline (NS) is commonly utilized, concerns regarding acid-base and electrolyte imbalances and the risk of acute kidney injury (AKI) have prompted the exploration of balanced fluids as an alternative. For a study, researchers sought to compare outcomes in patients with moderate to severe TBI treated with Sterofundin (SF) versus NS.

A double-blinded randomized controlled trial involving patients aged 18 to 65 with TBI was conducted at the University Malaya Medical Centre from February 2017 to November 2019. Participants were randomly allocated to receive either NS or SF, with the study fluids administered for 72 hours as continuous infusions or boluses. Regarding the fluid type, participants, investigators, and staff were blinded. The primary outcome was in-hospital mortality, and relative risk (RR) with a 95% CI was calculated.

The analysis included 70 patients, 38 in the NS and 32 in the SF groups. In-hospital mortality rates were 3 (7.9%) in the NS group versus 4 (12.5%) in the SF group, yielding an RR of 1.29 (95% CI, 0.64 to 2.59; P = 0.695). No patients developed AKI requiring renal replacement therapy. Intracranial pressure (ICP) on day 3 was significantly higher in the SF group (18.60 ± 9.26) compared to the NS group (12.77 ± 3.63), with a mean difference of 5.83 (95% CI, −11.46 to 0.20;  P= 0.037). No significant differences were observed in 3-day biochemical parameters, cerebral perfusion pressure, ventilator-free days, length of ICU stay, or Glasgow Outcome Scale-Extended (GOS-E) score at 6 months.

In patients with moderate to severe TBI, the use of SF did not demonstrate a reduction in in-hospital mortality, development of AKI, or improvement in 6-month GOS-E compared to NS.

Reference: sciencedirect.com/science/article/abs/pii/S0735675723006800